The purpose of this paper is to evaluate the postoperative results in paediatric patients with osteoid osteoma. We present a retrospective study including 16 patients under 18 years old treated surgically in our institution between April 2019 and September 2020. Patient demographic data, clinical aspects and imaging studies used to establish the diagnosis, lesion location, the size of the nidus, surgical data, hospitalization periods, complications and particular conditions were noted.Sixteen patients with mean age of 11.19 years (between 5 and 17 years) were treated using surgical excision (open or minimal invasive) or radiofrequency ablation (RFA). All patients presented with night pain highly responsive to nonsteroidal anti-inflammatory drugs. Imaging studies before surgery included radiographs, CT scans and/or MRI, technetium-99 bone scans. Interval between symptoms onset and surgery varied from 3 to 18 months (mean 8.18 months). Eight patients were treated using radiofrequency ablation under fluoroscopy, 5 cases were treated using minimal invasive surgery (resection-biopsy with trocar) and 3 cases were treated by open surgical excision. We have obtained histopathologic diagnosis in all cases. One patient had a superficial wound infection and two patients presented recurrent pain. In 13 patients the pain disappeared during the first 48 hours after surgery. Mean follow-up time was 10.12 months.RFA is the treatment of choice in paediatric cases of osteoid osteoma. Vicinity of important anatomical structure are contraindications for RFA. Using ablation probes with cooled tips may result in more predictable outcomes. The tendency to use less and less invasive procedures in the surgical fields seems to lead to development of non-invasive procedure.
The evolution of modern medicine, in its continuous developing process, is highly connected with the progress achieved in the medical branch of technology. Regarding the surgical specialties, the technological progress breakthroughs may determine the appearance of new diagnosis techniques, but also shape innovative treatments, leading to superior therapeutic results. In the surgical treatment as a whole, an essential role is played by the Medical Imagistics. They either offer the much-needed visual support in order to reach an accurate diagnosis, or guide the surgeon in choosing a certain type of intervention. The importance of Imagistics is indisputable. It has also been proven so in intraoperatory guidance and monitoring the patient in post-surgery. In the evolution of medical Imagistics, after the transition to digital imaging, followed by graphic 3D reconstructions based on CT and MRI data, we find ourselves contemporary with a new turning point announcing a technological revolution: the transition from virtual 3D models to tangible 3D replica. Since the beginning, the 3D printing technology has been of great importance to the field of medical research and, once the technique gained popularity, it became a modern tool for many medical specialties, in particular for cranio-maxillofacial surgery, orthopedics, oncology, neurosurgery. The 3D printing technology managed to transgress dated barriers by facilitating the manufacturing of implants or implement new treatments in regenerative medicine. The purpose of this original paper is to present our 3D printing work protocol and general conclusions after 5 years of implementing 3D printing in pediatric orthopedics.
Introduction. Congenital fibrosarcoma is a rare soft tissue neoplasm, distal extremities being more commonly involved. This tumor has a rapid growth and extensive local invasion, but metastasis is rare. It is usually observed in children younger than two years old and is present at birth in up to 30% of the cases. Purpose. Evaluation of the methods of diagnosis and treatment in a case of a newborn known from intrauterine life, with a large tumor of the right arm. Materials and methods. We present the case of a 1-day-old patient, who was transferred from maternity in our clinics with the following diagnostics: large tumor of the right thoracic member, cardiac insufficiency, prematurity, severe respiratory distress. The tumor was visible at ultrasonography from intrauterine life, and the evolution was the increase in volume with necrosis areas and hair presence on its surface. After imagistic investigation, taking into account the tumoral extension with neurovascular involvement, without the possibility of a tumoral resection, but also the imminent danger of spontaneous rupture, we decided to perform a shoulder disarticulation without a biopsy in advance. Results. Postoperative evolution and the treatment of the cardiac insufficiency were good under antibiotics. The histopathological results advocate for the diagnosis of congenital fibrosarcoma, also confirmed by immunohistochemical tests. Conclusions. Soft tissue tumors are very rare and they need a multidisciplinary evaluation for the establishment of the right treatment. Imagistic and laboratory investigations can guide the diagnosis and the therapeutical conduct. The certainty diagnosis is established only after the histopathological results.
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