Re-excision with adjuvant therapy proved to be a safe and effective method for treating the disease and preserving limb function.

Therapeutic study, level IV (case series).

A retrospective review was performed of all osteochondroma excisions at our institution from 1994 to 2007. Postoperative functional assessment was completed with use of the Disabilities of the Arm, Shoulder and Hand (DASH) survey and a self-report questionnaire. Eight osteochondromas were excised at a mean patient age of 21.63 years. Presenting reports included pain, mass, pseudowinging, and snapping of the scapula. Physical examination identified pseudowinging, palpable mass, and pain with shoulder motion. The lesions arose from the ventral surface of the scapula in 5 patients, the dorsal surface in 2, and the inferior acromion in 1. The resected specimen averaged 10.8cm(3). A reactive bursa was found and resected in 4 patients. At mean of 4.17 years postresection, no signs of recurrence were found in 7 patients (88%). The single patient with a recurrence had undergone 2 additional surgical procedures. Six patients (75%) reported no/mild pain with routine and strenuous activities. One patient reported moderate and 1 patient reported moderate/severe pain with routine and strenuous activities. Four patients reported post-resection function as excellent, 2 as good, 1 as average/good, and 1 as average/poor. Six patients (75%) reported feeling very satisfied with the results, 1 reported feeling satisfied, and 1 reported feeling unsatisfied. The average DASH score was 11.7 (range, 0.00-46.67). No winging or pseudowinging was identified in those available for examination, and no difference was identified in range of motion comparing the operative to the nonoperative upper extremity. Near normal functional outcomes can be expected following excision of scapular osteochondromas.

STUDY DESIGN The Spine End Results Registry (2003-2004) is a registry of prospectively collected data of all patients undergoing spinal surgery at the University of Washington Medical Center and Harborview Medical Center. Insurance data was prospectively collected and used in multivariate analysis to determine risk of perioperative complications. OBJECTIVE Given the negative financial impact of surgical site infections and the higher overall complication rates of patients with a Medicaid payer status, we hypothesized that a Medicaid payer status would have a significantly higher surgical site infection rate. SUMMARY OF BACKGROUND DATA The medical literature demonstrates lesser outcomes and increased complication rates in patients that have public insurance as compared to private insurance. No one has shown that patients with a Medicaid payer status as compared to Medicare and privately insured patients have a significantly increased surgical site infection rate for spine surgery. METHODS The prospectively collected Spine End Results Registry provided data for analysis. Surgical site infection was defined as treatment requiring operative debridement. Demographic, social, medical, and the surgical severity index risk factors were assesses against the exposure of payer status for the surgical procedure. RESULTS The population included Medicare (N=354), Medicaid (N=334), the Veterans’ Administration (N=39), private insurers (N=603), and self-pay (N=42). Those patients whose insurer was Medicaid had a 2.06 odds (95% CI: 1.19, 3.58, p=0.01) of having a surgical site infection when compared to the privately insured. CONCLUSION The study highlights the increased cost of spine surgeries for Medicaid patients with the passage of the Patient Protection and Affordable Care Act of 2010 (PPACA). The PPACA provisions could cause a reduction in re-imbursement to the hospital for taking care of patients with Medicaid insurance due to their higher complication rates and higher costs. This very issue could inadvertently lead to access limitations.

Elevated interstitial fluid pressure (IFP) is observed in most solid tumors. However, the study of the cellular processes of tumors and the development of chemotherapy are routinely studied using in vitro culture systems at atmospheric pressure. Using a new pressurized cell culture system, we investigated the influence of hydrostatic pressure on population dynamics of three primary osteosarcoma (HOS, U2OS, SaOS2) and two metastatic tumor cell lines (MCF7 breast, H1299 lung) that invade bone. Values of IFP in normal human bone and muscle, and in osteosarcoma tumors obtained during their surgical biopsy established the hydrostatic pressure range for the in vitro cell studies. The IFP values were obtained from a retrospective review of patient records. IFP from confirmed osteosarcoma was 35.9+/- 16.2 mmHg. Tumor IFP was significantly higher than muscle IFP (p < 0.001) and bone IFP (p < 0.003). The in vitro study measured the cell-line proliferation using hydrostatic pressures of 0, 20, 50 and 100 mmHg. The findings suggest that hydrostatic pressure either increases or decreases tumor proliferation rates depending on cell type. Furthermore, cell death was not associated with apoptosis.

No abstract

Therapeutic study, Level III-1 (retrospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.

3.