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Mainard D, Galois L. Treatment of a solitary calcaneal cyst with endoscopic curettage and percutaneous injection of calcium phosphate cement. J Foot Ankle Surg 2006; 45:436-40. [PMID: 17145470 DOI: 10.1053/j.jfas.2006.09.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Indexed: 02/03/2023]
Abstract
We report the case of a 35-year-old man who presented with pain in the right heel. Plain radiographs and computerized tomography revealed a solitary cyst of the calcaneus. Endoscopic curettage of the lesion and endoscopically assisted filling of the lesion with calcium phosphate bone cement injected percutaneously were performed. After 12 months, no recurrence was noted and the patient was symptom free.
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Ghodsi SZ, Raziei M, Taheri A, Karami M, Mansoori P, Farnaghi F. Comparison of cryotherapy and curettage for the treatment of pyogenic granuloma: a randomized trial. Br J Dermatol 2006; 154:671-5. [PMID: 16536810 DOI: 10.1111/j.1365-2133.2005.06923.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pyogenic granuloma is a benign vascular lesion of the skin and mucous membranes. Many different treatments have been used, with variable success rates. OBJECTIVES To evaluate and compare the effects of cryotherapy and curettage in the treatment of pyogenic granuloma. METHODS Eighty-nine patients with pyogenic granuloma were randomized to receive cryotherapy with liquid nitrogen or curettage and electrodesiccation. Forty patients in the cryotherapy group and 36 patients in the curettage group completed the study period. RESULTS Among the patients who completed the study, treatment resulted in complete resolution of all lesions after one to three sessions (mean 1.42) in the cryotherapy group and after one to two sessions (mean 1.03) in the curettage group. The difference between the two groups was statistically significant (P < 0.001). Twenty-three patients (57.5%) in the cryotherapy group and 25 patients (69%) in the curettage group had no scar or pigmentation abnormality. Except for cosmetic problems, no other side-effect or complication was recorded in the study. CONCLUSIONS This study showed that both cryotherapy and curettage are safe and effective. Curettage had the advantage of fewer treatment sessions required to achieve resolution and better cosmetic results. We suggest that curettage could be the first-line treatment for pyogenic granuloma.
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Condous G, Kirk E, Lu C, Van Calster B, Van Huffel S, Timmerman D, Bourne T. There is no role for uterine curettage in the contemporary diagnostic workup of women with a pregnancy of unknown location. Hum Reprod 2006; 21:2706-10. [PMID: 16790610 DOI: 10.1093/humrep/del223] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study was to generate and evaluate a new protocol that defined non-viability in the pregnancy of unknown location (PUL) population and therefore ensured no viable intra-uterine pregnancy (IUP) would be interrupted if uterine curettage was performed. A secondary aim was to evaluate published biochemical criteria that define non-viability in a PUL population to establish if these criteria could result in inadvertent termination of pregnancy (TOP) if uterine curettage was performed. METHODS All clinically stable women classified as having a PUL were included in this study. Protocol 1 was developed retrospectively based on data from 500 consecutive PULs. Using this protocol, no cases of viable IUPs would undergo uterine curettage and the potential for TOP was eliminated. This protocol was then validated prospectively on the data from a further 503 consecutive PULs. Results were then compared with three established criteria (Protocols 2-4) for the use of uterine curettage as a diagnostic tool to classify the location of PULs. Protocol 2 defined non-viability when the hCG ratio (hCG at 48 h/hCG at 0 h) was <or=1.66; Protocol 3 advised uterine curettage at serum hCG levels of >or=2000 U/l or when the initial serum hCG was <2000 U/l with a serum hCG rise of <35% over 48 h (hCG ratio<1.35); Protocol 4 advised uterine curettage with a serum hCG rise of <50% over 48 h (hCG ratio<1.50). The number of uterine curettages performed and viable IUPs that would have undergone an unplanned TOP were recorded for all protocols. RESULTS A total of 12 572 consecutive women were scanned: 1003 (8.0%) women were classified as PULs. Training set consisted of 500 PULs: 278 (55.6%) failing PULs, 176 (35.2%) IUPs and 46 (9.2%) ectopic pregnancies (EPs). Test set consisted of 503 PULs: 255 (50.7%) failing PULs, 203 (40.4%) IUPs and 45 (9.0%) EPs. Protocol 1 when developed retrospectively on the training set would have resulted in 293 uterine curettages and no potential TOP. Protocol 1 tested prospectively on 503 PULs would have resulted in 272 uterine curettages and no potential TOP. Three established criteria were tested on the entire data set (n=1003). Protocol 2 would have resulted in 114 uterine curettages and 14 (12.3%) potential TOPs; Protocol 3 would have led to 611 uterine curettages and seven (1.2%) potential TOPs; Protocol 4 would have resulted in 617 uterine curettages and three (0.5%) potential TOPs. No harm came to the women whose EP diagnosis was delayed. CONCLUSIONS Established criteria for the use of uterine curettage in the management of PULs, including those advocated by the American Society for Reproductive Medicine (ASRM), can theoretically result in an inadvertent TOPs. On the basis of these data, a change in contemporary clinical practice should be considered to avoid further damage to wanted pregnancies. We conclude that uterine curettage should not be used in the routine diagnostic workup of women with a PUL.
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Sharma JB, Chanana C, Gupta SD, Kumar S, Roy K, Malhotra N. Successful pregnancy outcome with elective caesarean section following two attempts of surgical excision of large giant cell tumor of the lower limb during pregnancy. Arch Gynecol Obstet 2006; 274:313-5. [PMID: 16770589 DOI: 10.1007/s00404-006-0123-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Accepted: 01/09/2006] [Indexed: 10/24/2022]
Abstract
CASE REPORT A 21 year old woman presented at 27 weeks of gestation with history of curettage of large giant cell tumor of distal left femur at 18 weeks of gestation with residual tumor. Repeat excision and bone grafting was performed with isoxsupine tocolysis. An elective caesarean was performed at term and a 3-kg healthy baby boy was delivered. Decision to perform an elective section was taken to avoid fracture of bone and also due to limited abduction of limb. Both mother and baby were discharged from the hospital on the fifth postoperative day. CONCLUSION Surgical excision of giant cell tumor with tocolysis followed by elective caesarean delivery is recommended for successful pregnancy outcome.
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Selva D, Lai T, Krishnan S. Orbitofrontal cholesterol granuloma: percutaneous endoscopic-assisted curettage. The Journal of Laryngology & Otology 2006; 117:892-4. [PMID: 14670153 DOI: 10.1258/002221503322542935] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper describes the use of endoscopic visualization in curettage of orbital cholesterol granuloma (OCG). Two males aged 54 and 50 years presented with orbitofrontal cholesterol granulomas arising in the superolateral frontal bone and abutting the dura. The granulomas were approached via a superior eyelid crease incision and a 70 degree rigid endoscope was used to visualize curettage of the granuloma from the inner surface of the frontal bone and the dura. Both patients made an uncomplicated recovery and there was no recurrence at eight months and two years follow up.Percutaneous endoscopic curettage is an alternative to blind curettage, lateral orbitotomy or frontal craniotomy for OCG.
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Vult von Steyern F, Bauer HCF, Trovik C, Kivioja A, Bergh P, Holmberg Jörgensen P, Follerås G, Rydholm A. Treatment of local recurrences of giant cell tumour in long bones after curettage and cementing. A Scandinavian Sarcoma Group study. ACTA ACUST UNITED AC 2006; 88:531-5. [PMID: 16567792 DOI: 10.1302/0301-620x.88b4.17407] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We retrospectively studied local recurrence of giant cell tumour in long bones following treatment with curettage and cementing in 137 patients. The median follow-up time was 60 months (3 to 166). A total of 19 patients (14%) had at least one local recurrence, the first was diagnosed at a median of 17 months (3 to 29) after treatment of the primary tumour. There were 13 patients with a total of 15 local recurrences who were successfully treated by further curettage and cementing. Two patients with a second local recurrence were consequently treated twice. At the last follow-up, at a median of 53 months (3 to 128) after the most recent operation, all patients were free from disease and had good function. We concluded that local recurrence of giant cell tumour after curettage and cementing in long bones can generally be successfully treated with further curettage and cementing, with only a minor risk of increased morbidity. This suggests that more extensive surgery for the primary tumour in an attempt to obtain wide margins is not the method of choice, since it leaves the patient with higher morbidity with no significant gain with respect to cure of the disease.
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Lee RS, Weitzel S, Eastwood DM, Monsell F, Pringle J, Cannon SR, Briggs TWR. Osteofibrous dysplasia of the tibia. ACTA ACUST UNITED AC 2006; 88:658-64. [PMID: 16645116 DOI: 10.1302/0301-620x.88b5.17358] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Osteofibrous dysplasia is an unusual developmental condition of childhood, which almost exclusively affects the tibia. It is thought to follow a slowly progressive course and to stabilise after skeletal maturity. The possible link with adamantinoma is controversial and some authors believe that they are part of one histological process. We retrospectively reviewed 16 patients who were diagnosed as having osteofibrous dysplasia initially or on the final histological examination. Their management was diverse, depending on the severity of symptoms and the extent of the lesion. Definitive (extraperiosteal) surgery was localised ‘shark-bite’ excision for small lesions in five patients. Extensive lesions were treated by segmental excision and fibular autograft in six patients, external fixation and bone transport in four and proximal tibial replacement in one. One patient who had a fibular autograft required further excision and bone transport for recurrence. Six initially underwent curettage and all had recurrence. There were no recurrences after localised extraperiosteal excision or bone transport. There were three confirmed cases of adamantinoma. The relevant literature is reviewed. We recommend extraperiosteal excision in all cases of osteofibrous dysplasia, with segmental excision and reconstruction in more extensive lesions.
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Afshar AR, Abbasi F. Photoclinic. Primary alveolar soft part sarcoma of bone. ARCHIVES OF IRANIAN MEDICINE 2006; 9:175-6, 181. [PMID: 16649367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Dormans JP, Sankar WN, Moroz L, Erol B. Percutaneous intramedullary decompression, curettage, and grafting with medical-grade calcium sulfate pellets for unicameral bone cysts in children: a new minimally invasive technique. J Pediatr Orthop 2006; 25:804-11. [PMID: 16294140 DOI: 10.1097/01.bpo.0000184647.03981.a5] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several treatment options exist for unicameral bone cysts (UBCs), including observation, steroid injection, bone marrow injection, and curettage and bone grafting. These are all associated with high recurrence rates, persistence, and occasional complications. Newer techniques have been described, most with variable success and only short follow-up reported. Because of these factors, a new minimally invasive percutaneous technique was developed for the treatment of UBCs in children. Twenty-eight children with UBCs who underwent percutaneous intramedullary decompression, curettage, and grafting with medical-grade calcium sulfate (MGCS) pellets by the senior author (J.P.D.) between April 2000 and April 2003 were analyzed as part of a pediatric musculoskeletal tumor registry at a large tertiary children's hospital. Four patients were lost to follow-up, and the remaining 24 patients had an average follow-up of 21.9 months (range 4-48 months). Twelve patients were followed for at least 24 months. Six of the 24 children had received previous treatment of their UBC, most often at an outside institution. Follow-up was performed through clinical evaluation and radiographic review. Postoperative radiographs at most recent follow-up showed complete healing, defined as more than 95% opacification, in 22 of 24 patients (91.7%). One patient (4.2%) demonstrated partial healing, defined as 80% to 95% opacification. One patient had less than 80% radiographic healing (4.2%). All 24 patients returned to full activities and were asymptomatic at most recent follow-up. The only complication noted was a superficial suture abscess that occurred in one patient; this resolved with local treatment measures. The new minimally invasive technique of percutaneous intramedullary decompression, curettage, and grafting with MGCS pellets demonstrates favorable results with low complication and recurrence rates compared with conventional techniques. The role of intramedullary decompression as a part of this percutaneous technique is discussed.
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Fenichel I, Garniack A, Morag B, Palti R, Salai M. Percutaneous CT-guided curettage of osteoid osteoma with histological confirmation: a retrospective study and review of the literature. INTERNATIONAL ORTHOPAEDICS 2006; 30:139-42. [PMID: 16474938 PMCID: PMC2532079 DOI: 10.1007/s00264-005-0051-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Revised: 11/16/2005] [Accepted: 12/05/2005] [Indexed: 10/25/2022]
Abstract
Osteoid osteoma is a benign bone tumour usually occurring in young individuals (10-30 years). It presents with intense pain (typically nocturnal), which can be alleviated by salicylates. Treatment consists of surgical excision or destroying the nidus and it is curative. In the past, surgery was performed in an "open" fashion and the nidus had to be removed with a bone block. This extensive type of surgery could be associated with some rates of both failure and complication. There is growing evidence to suggest that percutaneous CT-guided removal or destruction of the nidus is a good alternative and it is indeed gaining worldwide popularity. We present a series of 18 consecutive patients with osteoid osteoma of the pelvis, femur, and tibia, treated percutaneously under CT guidance. Removal of the nidus was performed using a 4.5-mm cannulated drill and a cannulated curette of our own design. Tissue samples for histological evaluation were obtained in the same way. The mean follow-up time was 29 months. Sixteen patients were initially cured. The procedure had to be repeated in two patients and was eventually successful (primary and secondary success rates 88 and 100% respectively). The diagnosis was histologically confirmed in 14 cases out of 18 (77%). In four cases no histological confirmation of osteoid osteoma could be achieved. There were only two minor complications, one case of femoral neuropraxia and one case of skin abrasion. Percutaneous CT-guided removal seems to be efficient and safe for the treatment of osteoid osteoma. The use of a cannulated drill and a cannulated curette facilitates efficient removal of the tumour and procurement of tissue for diagnosis.
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Nakase H, Matsuda R, Shin Y, Park YS, Sakaki T. The use of ultrasonic bone curettes in spinal surgery. Acta Neurochir (Wien) 2006; 148:207-12; discussion 212-3. [PMID: 16311841 DOI: 10.1007/s00701-005-0655-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Accepted: 09/22/2005] [Indexed: 10/25/2022]
Abstract
OBJECT The author describes a clinical applications, procedure, and efficacy of ultrasonic bone curette (UBC) (bone-removal bar) in spinal surgery. METHODS From July 2003 to March 2005, we operated on 98 consecutive spinal disorders by using UBC, Sonopet UST-2001; Chiari type-1 malformation (6 cases), cervical disorders (64 cases), thoracic disorders (5 cases), and lumbar disorders (23 cases). The instrument was devoid of any spinning parts, and the risk of grabbing cotton pledgets and damaging normal tissue was thereby avoided. Support from assistants for irrigation and suction was not required. FINDINGS In this series, there were no iatrogenically induced injuries for example, direct or heat damage to surrounding soft tissues, including nerves, vessels, spinal cord, and dura matter. Considering potential complications of mechanical injuries by ultrasonic technique, intermittent usage and cotton protection during use under an operating microscope are recommended. We found that the ultrasonic device is easy to handle; however, it is time consuming for removing a large amount of bone and ossified lesions. Therefore, we recommend the combined use of this method with standard drilling. CONCLUSIONS This system appears to be versatile, safe, and efficient in spinal surgery and could be improved by the development of a better handpiece.
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Wu JK, Oh C, Strutton G, Siller G. An open-label, pilot study examining the efficacy of curettage followed by imiquimod 5% cream for the treatment of primary nodular basal cell carcinoma. Australas J Dermatol 2006; 47:46-8. [PMID: 16405483 DOI: 10.1111/j.1440-0960.2006.00222.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
SUMMARY The short-term efficacy of imiquimod 5% cream for the treatment of primary superficial basal cell carcinoma has been established. This study investigated its efficacy following curettage (without electrodesiccation) for the treatment of primary nodular basal cell carcinoma on the trunk and limbs. Seventeen patients with a total of 34 lesions were enrolled. Curettage was used to de-bulk the lesion and confirm suitable histology. Lesions displaying more aggressive subtypes (such as micronodular or morpheoic components) were excluded. Lesions were treated daily for 6 to 10 weeks with imiquimod 5% cream. Three months post treatment all lesions were excised, and 32 of 34 treated lesions (94%) were histologically clear of basal cell carcinoma. Fourteen of 17 patients rated the cosmetic outcome of treatment as excellent or good. Curettage followed by imiquimod 5% cream is effective for the treatment of primary nodular basal cell carcinoma on the trunk and limbs, and most patients are pleased with the cosmetic outcome.
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Steinkraus V, Boer A. Treatment of actinic keratoses: Why, when and how? Indian J Dermatol Venereol Leprol 2006; 72:331-3. [PMID: 17050925 DOI: 10.4103/0378-6323.27747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hardes J, Scheil-Bertram S, Gosheger G, Schulte M. Fibromyxoma of bone: a case report and review of the literature. Acta Orthop Belg 2006; 72:100-4. [PMID: 16570905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
In this study, a case of fibromyxoma of the proximal femur in a 59-year old woman is reported. The classification of this rare bone tumour is still a matter of debate and some investigators have suggested that these lesions represent a degenerative form of fibrous dysplasia. Some authors make a further distinction between fibromyxoma and myxoma of bone. In a review of 23 cases of fibromyxoma and five cases of myxoma, no differences in clinical, radiographic and biologic behaviour between fibromyxoma and myxoma were found. Apart from the age at diagnosis, the most important difference between fibromyxoma and myxoma was the degree of myxoid matrix. Therefore, we suggest that extragnathic myxoma is a regressive variant of extragnathic fibromyxoma and should be termed as the same entity. In contrast to monostotic fibrous dysplasia fibromyxoma / myxoma often causes pain and presents as a Lodwick IC lesion with a soft tissue mass. Therefore, fibromyxoma / myxoma should be distinguished from fibrous dysplasia because of its different clinical and radiographic features.
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Abstract
Giant cell tumor is a common benign bone tumor that possesses specific features including location at the end of long bone, a strong tendency toward local recurrence, and the rare capacity to metastasize to the lungs. Preferred treatment usually consists of extensive curettage and filling of the cavity with bone graft or cement. Debate still exists about the usefulness of local adjuvant treatment. Functional outcome is usually very good.
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191
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Gojnic M, Dugalic V, Jeremic V, Filimonovic D, Arsenijevic L. Endometrial carcinoma and hormonal disturbances in middle-aged women--an overview. EUR J GYNAECOL ONCOL 2006; 27:409-10. [PMID: 17009638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Endometrial hyperplasias and endometrial adenocarcinomas present a morphological continuity. In 1,150 cases of patients admitted to two hospitals over the past two years with diagnosed irregular bleeding, suspected ultrasonography findings and positive family history, we performed, not only hormonal examinations, but also fractioned explorative curettage after receiving patient consent.
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van Trommel NE, Massuger LFAG, Verheijen RHM, Sweep FCGJ, Thomas CMG. The curative effect of a second curettage in persistent trophoblastic disease: a retrospective cohort survey. Gynecol Oncol 2005; 99:6-13. [PMID: 16085294 DOI: 10.1016/j.ygyno.2005.06.032] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Revised: 06/14/2005] [Accepted: 06/16/2005] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the curative effect of a second curettage in patients with low-risk Persistent Trophoblastic Disease (PTD) after molar pregnancy. METHODS A retrospective cohort survey was performed on 2122 patients registered with the Dutch Central Registry for Hydatidiform Moles between 1987 and 2003. Of these, 422 patients developed PTD. For various reasons, 128 patients were excluded. The study group comprised 85 patients with, according to the Dutch guidelines, low-risk PTD who underwent a second therapeutic curettage as a part of the treatment for PTD. The control group consisted of 209 patients with low-risk PTD who did not undergo a second curettage. Patients in the study and control group were classified for high/low-risk PTD according to the internationally accepted FIGO 2000 guidelines. Primary outcome measures were the need for chemotherapy and if applicable, the number of chemotherapy courses. RESULTS After second curettage, eight out of 85 patients (9.4%) did not need additional chemotherapy which significantly differs from the 209 patients in the control group who all needed chemotherapy (P < 0.001). A debulking effect of the second curettage was observed: a median of 6 courses (interquartile range 3 courses) in the control group versus 5 courses (interquartile range 3 courses) in the study group (P = 0.036). Four out of the 85 (4.8%) patients with a second curettage had a major complication (uterine perforation or hemorrhage), which was managed conservatively. CONCLUSION A second curettage cured 9.4% of patients with PTD in this historical cohort and reduces the number of courses of chemotherapy. A second curettage seems to benefit only a limited number of patients with PTD. A randomized controlled prospective trial is needed to confirm this observation.
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Menapace R, Wirtitsch M, Findl O, Buehl W, Kriechbaum K, Sacu S. Effect of anterior capsule polishing on posterior capsule opacification and neodymium:YAG capsulotomy rates: Three-year randomized trial. J Cataract Refract Surg 2005; 31:2067-75. [PMID: 16412917 DOI: 10.1016/j.jcrs.2005.08.051] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2005] [Accepted: 03/13/2005] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare the long-term effect of extensive polishing and nonpolishing of the anterior lens capsule on posterior capsule opacification (PCO) and neodymium:YAG (Nd:YAG) capsulotomy rates. SETTING Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS This prospective randomized bilateral double-masked study included 108 eyes of 54 consecutive patients with age-related cataract. Following phacoemulsification, 3-piece intraocular lenses (IOLs) with round-edged silicone optics were implanted. Patients received an Allergan SI-40 IOL with a truncated, round optic edge or a Domilens Silens6 IOL with a fully round optic edge. Patients were randomly assigned to have extensive anterior capsule polishing with the Menapace aspiration curette or no treatment in the first eye; the second eye received the opposite treatment. Digital retroillumination images were taken at 1 week, 1 year, and 3 years, and Nd:YAG capsulotomy rates were evaluated. Posterior capsule opacification was objectively scored using automated image analysis software (AQUA) or estimated based on clearly defined assumptions if a capsulotomy had been performed. RESULTS Thirty-nine patients (78 eyes) concluded the study. Three-year PCO scores after polishing did not differ significantly (P>.05). However, 21 polished eyes (53.8%) required Nd:YAG laser capsulotomy compared with 14 nonpolished eyes (35.9%). The mismatch between PCO scores and Nd:YAG rates resulted from a change in PCO morphology that is not detected by scoring methods based on retroillumination photography but is visually disturbing to patients. CONCLUSIONS Polishing the anterior capsule was effective in reducing fibrotic opacification but ineffective in reducing regeneratory opacification. Changes in regeneratory PCO morphology not picked up by retroillumination photography increased the need for Nd:YAG laser capsulotomy.
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Mankin HJ, Hornicek FJ, Ortiz-Cruz E, Villafuerte J, Gebhardt MC. Aneurysmal bone cyst: a review of 150 patients. J Clin Oncol 2005; 23:6756-62. [PMID: 16170183 DOI: 10.1200/jco.2005.15.255] [Citation(s) in RCA: 251] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We have reviewed a series of 150 aneurysmal bone cysts treated over the last 20 years. PATIENTS AND METHODS The lesions were principally located in the tibia, femur, pelvis, humerus, and spine and, in most cases, presented the imaging appearance originally described by Jaffe and Lichtenstein as a blowout with thin cortices. RESULTS Only one of the patients was believed to have an osteoblastoma of the spine with secondary development of an aneurysmal bone cyst, and none of the patients developed additional lesions. The patients were treated primarily with curettage and implantation of allograft chips or polymethylmethacrylate, but some patients were treated with insertion of autografts or allografts. The local recurrence rate was 20%, which is consistent with that reported by other centers. CONCLUSION Aneurysmal bone cysts are enigmatic lesions of unknown cause and presentation and are difficult to distinguish from other lesions. Overall, the treatment is satisfactory, but it is possible that newer approaches, such as improved magnetic resonance imaging studies, may help diagnose the lesions and allow the physicians to plan for more effective treatment protocols.
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Chung VQ, Bernardo L, Jiang SB. Presurgical curettage appropriately reduces the number of Mohs stages by better delineating the subclinical extensions of tumor margins. Dermatol Surg 2005; 31:1094-9; discussion 1100. [PMID: 16164856 DOI: 10.1097/00042728-200509000-00002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Whether presurgical curettage (PC), light curettage performed before Mohs surgery to delineate tumor margin, is appropriate or causes unnecessary removal of normal tissue has not been well established. OBJECTIVE We aim to determine histologically whether PC appropriately increases the size of the stage I specimen or causes unnecessary removal of healthy tissue. METHODS Before a surgical margin guided by PC was taken, a hypothetical margin determined by visual and tactile assessment alone (no curettage [NC]) was marked outside the clinically defined tumor. Histologic analysis at the NC and the PC margins revealed whether the increase in the stage I specimen as a result of PC was appropriate. RESULTS PC appropriately increased the stage I specimen in 21 cases and unnecessarily removed normal tissue in only 1 case. The estimation of tumor margins with PC was 15 times more accurate than with NC (p value = .0012). CONCLUSION For basal cell and squamous cell carcinomas at least 4 mm in diameter, light curettage performed prior to Mohs surgery could better delineate subclinical extensions of the tumor margin and appropriately increase the size of the stage I specimen.
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Suzuki M, Kim T, Tamai H, Fujiyoshi T, Moriya H. Giant geode treated with calcium phosphate cement in a rheumatoid knee. J Rheumatol 2005; 32:1846-8. [PMID: 16142888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Lackman RD, Hosalkar HS, Ogilvie CM, Torbert JT, Fox EJ. Intralesional curettage for grades II and III giant cell tumors of bone. Clin Orthop Relat Res 2005; 438:123-7. [PMID: 16131880 DOI: 10.1097/01.blo.0000180051.27961.c3] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Grade III Campanacci lesions are traditionally treated with wide resections based on their postulated aggressiveness and potential for local recurrence and metastasis. The purpose of this study was to determine if there was a difference in local recurrence rates of Grade II and III lesions treated with intralesional curettage, burring, phenol cauterization, and polymethylmethacrylate application. Sixty-three patients (26 Campanacci Grade II and 37 Grade III lesions) met the inclusion criteria. No pathologic fractures, including intraarticular fractures, were included in this study. Followup averaged 108 months (range, 25-259 months). The overall local recurrence rate was 6% (4 of 63 patients), with no observed difference between Grade II and III lesions. The average Musculoskeletal Tumor Society functional score was 27.9/30 (93%). The mean range of motion of the adjacent joint was 97%. Patients with radiographic signs of osteoarthritis before treatment did not show substantial progression, and only one patient developed radiographic signs of degenerative arthritis postoperatively. Our distal metastatic rate was 3.2%. These data support the use of intralesional curettage and burring with adjuvant phenol and polymethylmethacrylate even in Grade III lesions, in the absence of pathologic fracture, regardless of the presence or extent of extraosseous extension. LEVEL OF EVIDENCE Therapeutic study, Level III-1 (retrospective cohort). See the Guidelines for Authors for a complete description of levels of evidence.
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De Lorenzi C. Successful treatment of acute periprosthetic breast infection with curettage, pulse lavage, and immediate device exchange. Aesthetic Plast Surg 2005; 29:400-3. [PMID: 16075354 DOI: 10.1007/s00266-004-0132-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute periprosthetic breast infection in aesthetic surgical patients is a rare event. These patients would be expected to be less tolerant of the standard option of removing the infected implant and waiting 6 months (or possibly more) for tissue conditions to become favourable prior to reinsertion. This report provides confirmatory evidence of a controversial method of management that involves removal of the infected implant, curettage of granulation tissue within the breast implant pocket, pulsed lavage, then switching to a "clean" setup (including gloves, gowns, drapes and instruments) and reinsertion of a new device with suction drainage. The technique allows for immediate replacement of the implant and if successful, obviates the need for any waiting period. Surgeons are encouraged to consider this management option in specific cases where tissue vascularity and patient health are satisfactory.
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Suneja R, Grimer RJ, Belthur M, Jeys L, Carter SR, Tillman RM, Davies AM. Chondroblastoma of bone: long-term results and functional outcome after intralesional curettage. ACTA ACUST UNITED AC 2005; 87:974-8. [PMID: 15972914 DOI: 10.1302/0301-620x.87b7.16009] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We undertook this retrospective study to determine the rate of recurrence and functional outcome after intralesional curettage for chondroblastoma of bone. The factors associated with aggressive behaviour of the tumour were also analysed. We reviewed 53 patients with histologically-proven chondroblastoma who were treated by intralesional curettage in our unit between 1974 and 2000. They were followed up for at least two years to a maximum of 27 years. Seven (13.2%) had a histologically-proven local recurrence. Three underwent a second intralesional curettage and had no further recurrence. Two had endoprosthetic replacement of the proximal humerus and two underwent below-knee amputation after aggressive local recurrence. One patient had the rare malignant metastatic chondroblastoma and eventually died. The mean Musculoskeletal Tumour Society functional score of the survivors was 94.2%. We conclude that meticulous intralesional curettage alone can achieve low rates of local recurrence and excellent long-term function.
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