Prognostic factors in patients with primary cutaneous anaplastic large cell lymphoma: a multicentric, retrospective analysis of the Spanish Group of Cutaneous Lymphoma

BACKGROUND

Reliable prognostic factors for patients with primary cutaneous anaplastic large cell lymphoma (PCALCL) are lacking.

OBJECTIVE

To identify prognostic factors for specific survival in patients with PCALCL.

METHODS

Using the convenience sampling method, patients with PCALCL diagnosed from May 1986 to August 2017 in 16 University Departments were retrospectively reviewed.

RESULTS

One hundred eight patients were included (57 males). Median age at diagnosis was 58 years. All of them showed T1-3N0M0 stages. Seventy per cent of the cases presented with a solitary lesion, mostly at the limbs. Complete response rate after first-line treatment was 87%, and no advantage was observed for any of them (surgery, radiotherapy, chemotherapy or other approaches). Nodal and visceral progression rate was 11% and 2%, respectively. 5-year specific survival (SSV) reached 93%; 97% for T1 patients and 84% for T2/T3 patients (P = 0.031). Five-year SSV for patients developing early cutaneous relapse was 64%; for those with late or no relapse, 96% (P = 0.001). Estimated median SSV for patients showing nodal progression was 103 months (95% CI: 51-155 months); for patients without nodal progression, estimated SSV did not reach the median (P < 0.001). Nodal progression was an independent predictive parameter for shorter survival (P = 0.011).

CONCLUSION

Multiple cutaneous lesions at presentation, early skin relapse and nodal progression portrait worse prognosis in patients with PCALCL.

[Analysis of the failures of a cemented constrained liner model in patients with a high dislocation risk]

OBJECTIVE

To evaluate the short-term results of an ultra high molecular weight polyethylene retentive cup in patients at high risk of dislocation, either primary or revision surgery.

MATERIAL AND METHOD

Retrospective review of 38 cases in order to determine the rate of survival and failure analysis of a constrained cemented cup, with a mean follow-up of 27 months. We studied demographic data, complications, especially re-dislocations of the prosthesis and, also the likely causes of system failure analyzed.

RESULTS

In 21.05% (8 cases) were primary surgery and 78.95% were revision surgery (30 cases). The overall survival rate by Kaplan-Meier method was 70.7 months. During follow-up 3 patients died due to causes unrelated to surgery and 2 infections occurred. 12 hips had at least two previous surgeries done. It wasn't any case of aseptic loosening. Four patients presented dislocation, all with a 22 mm head (P=.008). Our statistical analysis didn't found relationship between the abduction cup angle and implant failure (P=.22).

CONCLUSIONS

The ultra high molecular weight polyethylene retentive cup evaluated in this series has provided satisfactory short-term results in hip arthroplasty patients at high risk of dislocation.

Radiologic evaluation of the cement mantle in the femoral shaft. A comparative study using a fast-set or a standard-set cement

INTRODUCTION

At present a wide spectrum of cement types are available for cemented total hip arthroplasty (CTHA). All types have the same objective, i.e. to prolong the life of the implant for as long as possible. The purpose of this study was to compare the radiologic cement mantle of CTHA using cement with fast or standard setting characteristics.

METHOD

A prospective comparative study of patients who underwent CTHA was performed: the first group received fast setting cement (Cemex System Fast), the second group received standard setting cement (Cemex System). A radiologic evaluation of the cement mantle was done using Barrack's classification. In order to give the study clinical relevance we assembled Barrack's classification in two groups: 1) Low risk group (Types A and B); 2) High risk group (Types C and D). According to ISO 5833:2002, the international standard was used to perform physico-chemical (polymerization temperature, setting time) and mechanical testing (compression strength, bending strength and bending modulus).

RESULTS

The fast setting cement showed a shorter setting time and a higher polymerization temperature. The mechanical performances of both cements met the ISO limits. At a mean follow-up of 23 months (11-37 months) no statistically significant radiological difference was found in the radiologic cement mantle between the two groups either in the post-operative X-ray evaluation (p=0.32) or in the last follow-up (p=0.72). Statistical evaluation was done comparing the two sub-groups, i.e. low risk and high risk.

CONCLUSIONS

The use of fast or standard setting cement does not produce any difference in the quality of the radiologic cement mantle in the short-term. Both cements comply with ISO 5833 requirements.

Allograft reconstruction of the distal humerus after resection of a breast solitary metastasis: eleven years follow-up

Resection is a rare indication for the treatment of solitary skeletal metastasis (SSM), and provides an opportunity to cure the oncologic patient. Reconstruction after resection can imply a difficult problem depending on the size and the location of the metastasis. In the reported case, an en-bloc resection of a SSM of a breast cancer located in the distal humerus was performed in 1990. Reconstruction of the osteoarticular defect has been achieved with a massive allograft. At eleven years follow-up the patient remains free of illness and shows a good functional result. With the result obtained in the reported case, we suggest that osteoarticular allograft can be of considerable value for reconstruction after excision of SSM in the distal humerus, and that cure can be achieved with the radical resection of a SSM of breast cancer.

The use of proximal femoral allografts in revision total hip arthroplasty

The implant of a proximal femoral structural allograft is one of the possibilities to restore circumferential defects of multiply revised total hip arthroplasties. A review of 7 patients who underwent proximal femoral reconstruction with an allograft-prosthesis composite to restore bone loss in revision hip replacements is presented. The average follow-up period was 50.2 months. Two patients developed an infection and in one case an instability of the prosthesis appeared. Incorporation in the remaining 5 cases was/achieved in an average period of 8.2 months. Neither fractures nor high rate of resorption appeared in our series. The majority of patients have improved in the functional assessment. Despite the rate of complications, structural femoral allografts can be used with success in this difficult challenge of reconstructing major segmental bone loss of the proximal femur in revision hip surgery.

Long-term results of hemipelvic allograft: Report of four cases

Reconstruction after the excision of pelvic tumors involving the pelvic ring implies difficult problems. Restoration of the function is difficult and an allograft can be one of the possible solutions. Pelvic allograft is recommended by many authors to reconstruct the pelvic ring following extensive resections of bone tumors. Between 1988 and 1989, we performed hemipelvic resection and allograft reconstruction in 4 patients with pelvic sarcomas. The mean age was 42.3 years (range 38-48), consists of 3 male and 1 female. One case developed an infection and one case showed recurrence, both responding to surgical treatment. Outcome in those cases in which surgery was curative to the primary tumor was satisfactory at 10 years follow-up, with a mean total Enneking score of 25.3 (range 24-27) and a good functional result in Merlé D'Aubigne functional score. Despite the limited number of cases presented, our results added to the reported results in the literature led us to consider that allografts are valuable in pelvic reconstructions after en-bloc resections for bone tumors.

Behaviour of bone allografts in the advancement of the tibial tuberosity

In order to determine the behaviour of bone allografts in the advancement of the tibial tuberosity, we studied retrospectively 134 knees belonging to 119 recipients of frozen bone allograft for the treatment of a symptomatic patellofemoral osteoarthrosis. All patients had a 1.2-1.5 cm tibial tuberosity advancement with a release of the lateral patellar retinacula and no other additional surgery. Total incorporation of grafts took place in 116 cases (86.6%); graft resorption appeared in 16 patients (11.9%)(total resorption 3, and partial resorption 13). No disease transmission has been detected. To avoid donor site morbidity associated with harvesting iliac crest, the use of frozen bone allograft is a good alternative in the advancement of the tibial tuberosity.

The procurement team as a factor of bone allograft contamination

We studied the effect of the procurement team on the risk of contamination in 270 large bone allografts retrieved from 53 non-living donors under strictly aseptic conditions.The overall contamination rate was 8.1%. When the procurement team was constituted by three or less members the contamination rate was 5.6%, while if there were four or more members the rate was 12.9%; this difference was significant in the statistical analysis.We conclude that a procurement team constituted by three or less trained members is a determinant factor in decreasing the bacterial contamination rate of bone allografts.

Bone allograft contamination in multiorgan and tissue donors

Multiorgan and tissue donors offer a larger quantity and high quality of bone allograft that cannot be obtained from living donors. The risk of bone contamination must be borne in mind if secondary sterilization is not performed. The bacteriological cultures of 270 bone segments obtained from 53 multiorgan or tissue donors were analysed to study the relationship between previous organ and tissue procurements and bone retrieval contamination. We concluded that no significant differences in bacterial contamination percentage were found for each type of previous organ and tissue procurement, nor in the number of teams per donor.

Use of bone allograft in tibial plateau fractures

To determine the behaviour of bone allografts in the treatment of tibial plateau fractures, 20 recipients of frozen bone allograft for a depressed tibial plateau fracture were studied. Incorporation of grafts took place in all cases, and no complication secondary to the allograft use has been detected. To avoid donor site morbidity associated with harvesting iliac crest, the use of frozen bone allograft is a good alternative in the treatment of depressed tibial plateau fractures.

Unusual locations of osteoarticular tuberculosis

Tuberculosis continues to occur frequently in some underdeveloped regions. Bone and joint tuberculosis is less common than the pulmonary form. Fourteen cases of bone and joint tuberculosis in unusual locations are presented. Tuberculostatic treatment and surgical approach were associated in all the patients. In 6 cases an arthrodesis of the affected joint was carried out. A surgical debridement was done in 6 patients and a needle biopsy in 2 patients in order to obtain samples for pathology and bacteriology. Twelve of the 14 patients recovered. One patient who was affected by atlanto-axial tuberculosis died within the immediate postoperative period. A second one affected by the acquired immunodefiency syndrome died 4 months after surgery.

Septic arthritis of the shoulder due to Streptococcus agalactiae

The authors report a case of septic arthritis of the shoulder-joint due to group B beta-hemolytic Streptococci (Streptococcus agalactiae) in a 63-year-old female patient. These germs are a major cause of meningitis and septicemia in newborns and pregnant women. In adults, men and nonpregnant women, they have been a rare cause of septic arthritis.

Compression of the anterior interosseous nerve after use of a Robert-Jones type bandage for a distal end clavicle fracture: case report

There are some controversies in the medical literature about the causes of the anterior interosseous nerve (AIN) compression syndrome. The present case is, to our knowledge, the first reported resulting from an extrinsic compression of the AIN from a Robert-Jones type bandage in a patient with a distal end clavicle fracture.

Pubic osteolysis simulating a malignant lesion: case report

A case of posttraumatic osteolysis of the pubic bone simulating a malignant lesion in a 55-year-old woman is reported. A review of the literature revealed that all reported cases occurred in post-menopausal women, associated with radiologic evidence of osteoporosis and a history of slight trauma. Biopsy was performed because of the possible malignant nature of the lesion, which should be suspected in all post-menopausal women with a destructive lesion of the pubic bone.

Bacteriological study of surgical knives: is the use of two blades necessary?

Scalpel blades used in 115 operations were studied bacteriologically. In each case the knife used for skin incision was discarded immediately after the incision and a fresh knife was used to complete the operation. The scalpel blades were cultured in enriched thioglycolate and incubated at 37 degrees C. Readings were taken at 24 and 48 h. From positive cultures, colonies were isolated directly in solid media, and the germ was identified using routine tests. Results showed that there was no bacteriological evidence to justify the use of different blades for skin incision and deep dissection.

Comminuted intra-articular fractures of the distal end of the radius treated with the Hoffmann external fixator

In 1985 we began a prospective study of the use of external fixation in the treatment of intra-articular comminuted fractures of the distal end of the radius. A total of 30 patients have been treated by this method, representing 1.3% of the total number of patients treated in the Emergency Unit for a fracture of the distal epiphysis of the radius. The use of external fixation in instable fractures of the distal end of the radius improves the anatomic results. These correlate closely with the overall functional results obtained, which were excellent or good in 82.1% of cases, according to the rating system of Gartland and Werley. The main indications are fractures with a high degree of comminution, displacement, and articular affectation (unstable fractures) in young patients, corresponding to Frykman grades VII and VIII.