Dr. Ledian Fezollari discusses bone tumors in a document covering their classification, clinical presentation, investigations and treatment. Some key points:
- Primary malignant bone tumors make up 1% of all cancers but secondary bone tumors from other sites are more common.
- Presentation depends on age, with childhood cancers like osteosarcoma and Ewing's sarcoma more common. Myeloma is the most common bone tumor in those over 70.
- Investigations include imaging like x-rays, CT and MRI to determine location and extent of the tumor. Biopsies are also important.
- Treatment depends on tumor type and stage but may include chemotherapy, surgery like limb salvage procedures
“Don’t touch” lesions new version Dr Ahmed EsawyAHMED ESAWY
“Don’t touch” lesions new version dr ahmed esawy
CALCANEAL PSEUDOCYST
INTRAOSSEOUS LIPOMA
BIPARTITE PATELLA
MYOSITIS OSSIFICANS
AVULSION INJURY
CORTICAL DESMIOD
GEODES
DORSAL DEFECT OF THE PATELLA
PSEUDOCYST OF THE HUMURUS
OS ODONTOIDEUM
NON OSSIFYING FIBROMA
BONE ISLANDS
UNICAMERAL BONY CYST
EARLY BONE INFARCT
MELORHEOSTOSIS
HYPERTROPHIC PULMONARY OSTEOARTHROPATHY
ACHONDROPLASIA
AVASCULAR NECROSIS
HURLER SYNDROME
TRANSIENT OSTEOPOROSIS OF THE HIP
DIAPHYSEAL ACLASIA
MULTIPLE HEREDITARY EXOSTOSIS
OSTEOID OSTEOMA
OSTEPATHIA STRIATA
OSTEOPIKILOSIS
SARCIOD
OS STYLOIDEUM
OS TRIGONUM
“Don’t touch” lesions new version Dr Ahmed EsawyAHMED ESAWY
“Don’t touch” lesions new version dr ahmed esawy
CALCANEAL PSEUDOCYST
INTRAOSSEOUS LIPOMA
BIPARTITE PATELLA
MYOSITIS OSSIFICANS
AVULSION INJURY
CORTICAL DESMIOD
GEODES
DORSAL DEFECT OF THE PATELLA
PSEUDOCYST OF THE HUMURUS
OS ODONTOIDEUM
NON OSSIFYING FIBROMA
BONE ISLANDS
UNICAMERAL BONY CYST
EARLY BONE INFARCT
MELORHEOSTOSIS
HYPERTROPHIC PULMONARY OSTEOARTHROPATHY
ACHONDROPLASIA
AVASCULAR NECROSIS
HURLER SYNDROME
TRANSIENT OSTEOPOROSIS OF THE HIP
DIAPHYSEAL ACLASIA
MULTIPLE HEREDITARY EXOSTOSIS
OSTEOID OSTEOMA
OSTEPATHIA STRIATA
OSTEOPIKILOSIS
SARCIOD
OS STYLOIDEUM
OS TRIGONUM
Highly malignant tumor of mesenchymal origin.Spindle shaped cells that produce osteoid.2nd most common primary malignant bone tumor after MM.Incidence – 1 to 3 per million per year
Treated by chemo,amputation or rotationplasty
Identified in 1921 by James Ewing
2nd most common bone tumor in children
Ewing’s Sarcoma Family of tumors:
Ewing’s sarcoma (Bone –87%)
Extraosseous Ewing’s sarcoma (8%)
Peripheral PNET(5%)
Askin’s tumor
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. Introduction
Forms 0.2% of human tumor burden
Primary malignant bone tumors make 1% of all
malignant tumors.
Commonest bone tumour is secondaries from other
sites. 70% secondary, 30 % primary
4. Clinical presantation
Age
Childhood and adolesence:
Most benign, and some malignant (Osteosarcoma, Ewing
Sarcoma)
Decade 4-5 th:
Chondrosarcoma and Fibrosarcoma
Decade 6th:
Myeloma( the commonest primary malignant bone tumor)
Over 70 y.o:
Metastatic lesions are the commonest
5. Family History : may
be present in tumours
like exostosis/ von
recklenghausen`s
disease etc
Sex : Very few
tumours show sex
prediliction.
Eg GCT is commoner in
females.
Hereditary multiple exostosis
6. CLINICAL PRESENTATION- symptoms :
Pain :
Initially may be activity related, but in case of malignancy
there could be progressive pain at rest and at night.
In benign tumours, pain may be activity related when it is
large enough to compress surrounding soft tissue or when
it weakens bone.
7. Mass/ Swelling
In case of soft tissue
sarcomas patients may come
with mass rather than pain
but in some exceptions like
nerve sheath tumours, they
have pain and neurological
conditions.
Limitation of movement
Pathologic fracture
General symptoms
8. INVESTIGATIONS
Serological investigations
FBC
ERS
Serum protein
electrophoresis
Urine Bence Jones
protein
PSA, prostatic acid
phosphatase
Serum Calcium
Serum ALP
Antisarcoma antibodies
Osteocalcin – A
Flow Cytometry
10. INVESTIGATIONS: RADIOGRAPHS
• Phemister's Law = the most common site of
infection & tumours is the fastest growing site
of the long bone
• To see a lucent lesion in bone, an estimated
30 to 50 % of the bone must be lost
[Harris & Heaney, N Engl J Med 1969]
12. Radiography
I- Site
o Type of bone
Long bone / Flat bone
Epiphysis /Metaphysis
/Diaphysis
Intramedullary / Eccentric
/ Cortical lesion
The epicenter of the
tumor helps to determine
the origin
17. Zone of Transition
Most reliable indicator for benign versus malignant lesions.
“Narrow”, if it is so well defined that it can be drawn
with a fine-point pen.
“Wide”, if it is imperceptible and can not be drawn at all.
An aggressive process should be considered, although
not necessarily a malignant lesion.
Narrow zone Wide zone
18. Margins: 1A, 1B, 1C
IA: GEOGRAPHIC DESTRUCTION
WELL – DEFINED WITH
SCLEROSIS
IN MARGIN
IB: GEOGRAPHIC DESTRUCTION
WELL – DEFINED BUT NO
SCLEROSIS
IN MARGIN
IC : GEOGRAPHIC
DESTRUCTION
WITH ILL DEFINED MARGIN
increasing aggressiveness
III- Type of Bone Destruction
Type 1: Geographic destruction
19. Type 2: Moth-eaten destruction
Areas of destruction with
ragged borders
Implies more rapid growth
Probably a malignancy
osteosarcoma
20. Type 3: Permeative Pattern
ill-defined lesion
with multiple “worm-holes”
Spreads through marrow space
Wide transition zone
Implies aggressive malignancy
Round-cell lesions
Leukemia
Ewing sarcoma.
23. V- Types of matrix
Matrix appearance of the bone lesion. A, Solid pattern of radiodensity
indicates a bone matrix. B, Stippled appearance or, C, rings and arcs suggest a
cartilage matrix. D, Hazy, smoky, or ground glass appearance correlates to a
fibrous matrix of the lesion.
25. Imaging:
Radionuclide scanning (Bone scan)
• Locate small tumors.
• Identify secondary deposits or skip lesions.
• Computed Tomography (CT)
• Extension and staging.
• Identify metastasis to other organs.
• CT Angio; help operation planning in highly vascular tumors.
Magnetic Resonance Imaging (MRI)
• Assess tumor spreading.
• Detailed view for soft tissue.
• Examining cystic-like lesion contents.
26. Biopsy
• Needle biopsy
• Large bore biopsy needle.
• Ultrasound or CT guided.
• Carried out in the line of any further operation.
• Open biopsy
• More reliable.
• Preferred if there is risk damaging neurovascular structures with the
needle biopsy.
• Preferably from the boundary zone so it will contain (normal tissue,
pseudocapsule, and abnormal tissue).
• Excisional biopsy; for some benign tumors.
• Curettage for cystic lesions.
Core biopsy (Preferred)
Open biopsy:
Incisional (Preferred)
Excisional
Curettage
27. The Enneking staging system has been shown to
prognosticate survival for bone sarcomas !!!
28. Informed Consent
Natural hx of the disease
The various treatment options
Limb salvage
Amputation
Adjuvant therapy
Advantages and
disadvantages of Rx
29. Treatment
(General principles)
Treatment of choice in most bone and soft tissue
sarcomas
Preoperative radiation – soft tissue sarcomas
Neoadjuvant chemotherapy – bone sarcomas
Osteosarcoma & Ewing’s sarcoma
Neoadjuvant chemo & surgery
Chondrosarcomas
Not sensitive to chemotherapy or radiotherapy
Treatment is surgical
30. Treatment
(General principles)
Solitary bone lesion in previous hx of malignancy
Should not be assumed a metastatic lesion!
Surgical treatment of metastatic bone disease
Palliative
Multiple myeloma
Rx is mainly haematological
Surgery is for fracture & spinal cord compression
31. Treatment
(General principles)
Epiphyseal & metaphyseal lesions
Best treated with prosthetic replacement
In the shoulder
Prosthetic replacements have poor function
Internal fixation gives the best results
In the hip
Best treatment is arthroplasty
33. A set of surgical procedures designed to accomplish removal of a malignant
tumor and reconstruction of the limb with an acceptable oncologic, functional,
and cosmetic result**
Goal of limb salvage surgery
Condition that must achive:
1. Tumor free limb
2. Acceptable degree of function
3. Cosmetic appearance
4. Minimal amount of pain
5. Durable enough to withstand the
demands of normal daily activities
Combines two procedures-
Wide resection
Reconstruction of skeletal defect
Definition of limb salvage surgery
34. Indications
Every patient with tumor of the
extremity should be considered
for limb salvage if the tumor can
be removed with an adequate
margin and the resulting limb is
worth saving
No justification for limiting the
limb salvage process based only
on the prognosis
Survival rates should be no
worse than with amputation
Oncologic indications
IA, IIA
Good response to neoadjuvant
chemotherapy
36. Treatment
(Surgical Resections)
Stage IA:
Wide excision
Stage IIA:
Wide excision + Adjuvant
Stage IIB:
Radical resection + Adjuvant
Stage III:
Neoadjuvant, Radical
resection
Adjuvant Chemo -radiation
Treatment depends on the type of tumor and the stage
Not: Radical resection- May involve
amputation, disarticulation
37. BG (Vascularized / non-vascularized)
Allograft
Customized implants
Custom made prosthesis
Distraction osteogenesis
Arthrodesis
Treatment
(Management of defect after resection)
38. I. Short diaphyseal segments can be
replaced by vascularized or non-
vascularised bone grafts
II. Longer gaps may require custom –
made implants
III. Osteoarticular segments can be
replaced by endoprosthesis or
allograft-prosthetic composites
Principles of management of
defect after resection
39.
40.
41.
42.
43. Treatment
(Limb Salvage)
Advantage
Long time survival 20%→ 70%
The function of the salvaged limb is better than that of
the amputation but not normal function
Disadvantages
↑ morbidity (↑ risk of infection, wound dehiscence,
flap necrosis,blood loss & DVT)
Multiple future surgery
33% → amputation
44. Contraindications
Three strike rule
Bone
Nerves
Vessels
Soft tissue envelope
If three of these key components
are involved, the limb salvage is
probably not worth considering
Major neurovascular involvement
Displaced pathologic fracture
Fungating and infected tumors
Inability to afford chemotherapy or
poor response to neoadjuvant
chemio
Recurrence of malignant tumors
Complications sec to poorly
performed biopsy
Skeletal immaturity - 60% growth
occur through distal femoral and
proximal tibial epiphysis
Pulmonary metastasis is not a
contraindication of surgery
Contraindications of limb salvage
are the indications for amputation
49. Treatment
(Bone metastases)
Aim
Palliation
1. Prophylactic fixation of metastatic deposits where there is a
risk of fracture
2. Stabilization/Reconstruction following pathological fracture
3. Decompression of spinal cord & nerve roots and stabilization
for spinal instability
Not:Type of fixation depends on location
IM nailing for peritrochanteric lesions
Hemiarthroplasty for femoral neck & head lesions
50. Conclusion
The surgical management of malignant bone tumors presents
many challenges
With advances in chemotherapy, radiographic
imaging & reconstructive surgery; most patients
now can be offered limb-sparing surgery
Success depends on prompt detection and early referral by primary care
doctor and on careful and coordinated sequences of events
Achieving a surgical margin that will ensure a low rate of local
recurrence is paramount
Amputation still plays an important role & offers
a standard to which other approaches must be
compared
51. References
1. Campbell’s Operative Orthopaedics 13 edition
2. American Academy of Orthopaedic Surgeons
– Text book of Orthopaedic knowledge update 8
series
3. Samuel Turek Text Book of Orthopaedics: 3d
edition
4. www.uptodate.com/musculoskeletal tumours
5. WHO Manual 2001 reprint for Classification of
Musculoskeletal Tumours Ebnezer J. Bone
neoplasias. Textbook of orthopaedics, 2010; 4th
edition