ObjectiveGiant cell tumors are benign bone neoplasms that are relatively rare in adults and their biological behavior is still unpredictable. The incidence of local recurrence has presented variation between 0% and 65% in studies conducted worldwide, but few data are available on this complication in the Brazilian population.MethodsInformation on 155 patients with confirmed histological diagnoses of giant cell tumor who were treated in our institution's orthopedic oncology service between January 2000 and July 2014 was gathered. Demographic characteristics were evaluated and compared between patients who presented local recurrence during the clinical follow-up.ResultsLocal recurrence was observed in 26 patients (16.7%), of whom 22 were female (84.6%). The most common site of local recurrence was the distal femur (38.4%). Eleven patients presented early recurrence, while 15 cases were diagnosed after 15 months, representing 42.3% and 57.7%, respectively. Metastases were identified in five patients (3.2%).ConclusionTumor-related factors did not show any increased incidence of local recurrence of giant cell tumors. Surgical treatment with an intralesional margin is a valid option for treating local recurrences and does not show any difference in disease-free survival in relation to other types of procedures. Clinical treatment is reserved for cases of unresectable tumors or when surgical treatment is impossible.
The literature estimates that between 70 and 80% of dural ectasia occur in patients with Neurofibromatosis type I, also known as von Recklinghausen's disease. 1 Autosomal dominant disease of changerelated etiology on chromosome 17(17q11.2), in the gene NF1 2 responsible for the production of the protein neurofibromin, 3 being inherited in 50% of the cases, and by spontaneous mutation in the other 50%. It presents an incidence of 1: 3000, varying the statistic according to the region of the planet. 4 According to the NIH-National Institute of Health-the diagnosis is established by the presence of two or more characteristics within the seven: (1) six or more coffeewith-milk stains, (2) two or more neurofibromas; or a plexiform neurofibroma, (3) inguinal or axillary ephelides, (4) Lisch nodules in the iris, (5) optic glioma, (6) first-degree relative carrying the disease, and (7) typical skeletal alteration of the disease spectrum. 5 With a lower incidence, dural ectasia may also be present in patients with Marfan syndrome, Ehlers-Danlos syndrome and ankylosing spondylitis. 6
Objective: To evaluate the clinical and radiological results of posterior vertebral column resection in the treatment of kyphosis due to vertebral tuberculosis in children under 9 years of age with neurological deficit. Methods: Retrospective study of a series of 5 cases, 4 females and 1 male, mean age of 4.7 years at the time of surgery, with spinal tuberculosis and mean kyphosis of 89 degrees. Results: All patients underwent surgical treatment with PVCR in multiple levels, with a mean number of 3.6 resected vertebrae, mean surgical time of 359 minutes, mean postoperative stay of 21.2 days. The mean follow-up was 29 months. The mean kyphosis correction was 62.6%. Before surgery, all patients had signs of spinal cord injury, one of which did not present a deficit of strength or sensibility (ASIA E), but there were pyramidal signs and a history of falls. The other 4 had some degree of sensory-motor dysfunction, with ASIA score varying from A to D. Postoperative complications included two dehiscences of suture, one pneumothorax and one pneumonia, all with favorable evolution. Four patients progressed with neurological improvement and one of them had persistence of the neurological deficit until the last follow-up. Conclusions: Multiple-level PVCR has proven to be a safe and effective option for the treatment of kyphotic deformity in spinal tuberculosis in children with neurological deficit. Level of evidence IV; Case Series. RESUMOObjetivo: Avaliação dos resultados clínicos e radiológicos da vertebrectomia posterior multinível no tratamento da cifose por tuberculose vertebral em crianças menores de 9 anos apresentando déficit neurológico. Métodos: Estudo retrospectivo de uma série de 5 casos, sendo 4 do sexo feminino e 1 do sexo masculino, média de idade de 4,7 anos na época da cirurgia, portadoras de tuberculose vertebral múltiplos níveis, com média de cifose de 89°. Resultados: Todos os pacientes foram submetidos ao tratamento cirúrgico com RCVP múltiplos níveis, com número médio de 3,6 vértebras ressecadas, média de tempo cirúrgico de 359 minutos, período médio de internação pós-operatória de 21,2 dias. O seguimento médio foi de 29 meses. A média de correção da cifose foi de 62,6%. Antes da cirurgia, todos os pacientes tinham sinais de sofrimento medular, sendo que um deles não apresentava déficit de força ou sensibilidade (ASIA E), porém havia a presença de sinais piramidais e história de quedas. Os outros 4 possuíam algum grau de disfunção sensitivo-motora, com escore ASIA variando de A a D. Como complicações pós-operatórias ocorreram duas deiscências de sutura, um pneumotórax e uma pneumonia, todas com evolução favorável. Quatro pacientes evoluíram com melhora neurológica e um deles apresentou manutenção do déficit neurológico até o último seguimento. Conclusão: A RCVP múltiplos níveis se mostrou uma opção segura e eficaz no tratando da cifose na TB vertebral em crianças com déficit neurológico. Nível de evidência IV; Série de Casos. Descritores: Tuberculose da Coluna Vertebral; Compressão da Medula Espinhal;...
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