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The American Academy of Orthopaedic Surgeons has developed the Appropriate Use Criteria (AUC) for the Management of Developmental Dysplasia of the Hip in Infants up to Six Months of Age: Intended for Use by Orthopaedic Specialists. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The Management of Developmental Dysplasia of the Hip in Infants up to Six Months of Age: Intended for Use by Orthopaedic Specialists AUC clinical patient scenarios were derived from indications typical of patients presenting with developmental dysplasia of the hip in clinical practice. The 432 patient scenarios and three treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Next, a separate multidisciplinary, Voting Panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

The American Academy of Orthopaedic Surgeons has developed the Appropriate Use Criteria (AUC) for the Management of Developmental Dysplasia of the Hip in Infants up to Six Months of Age: Intended for Use by General Pediatricians and Referring Physicians. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The Management of Developmental Dysplasia of the Hip in Infants up to Six Months of Age: Intended for Use by General Pediatricians and Referring Physicians AUC clinical patient scenarios were derived from indications typical of patients presenting with developmental dysplasia of the hip in clinical practice. The 24 patient scenarios and four treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Next, a separate multidisciplinary, Voting Panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

The American Academy of Orthopaedic Surgeons, in collaboration with the American Dental Association, has developed Appropriate Use Criteria (AUC) for the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The Management of Patients with Orthopaedic Implants Undergoing Dental Procedures AUC clinical patient scenarios were derived from indications of patients with orthopaedic implants presenting for dental procedures, as well as from current evidence-based clinical practice guidelines and supporting literature to identify the appropriateness of the use of prophylactic antibiotics. The 64 patient scenarios and 1 treatment were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

The American Academy of Orthopaedic Surgeons has developed the Appropriate Use Criteria (AUC) for the Management of Osteoarthritis of the Hip. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The Management of Osteoarthritis of the Hip AUC clinical patient scenarios were derived from indications typical of patients presenting with osteoarthritis of the hip in clinical practice. The 270 patient scenarios and 9 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Next, a separate multidisciplinary, Voting Panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the Appropriate Use Criteria (AUC) document Postoperative Rehabilitation of Low Energy Hip Fractures in the Elderly to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The AUC clinical patient scenarios were derived from patient indications that typically accompany hip fractures, as well as from current evidence-based clinical practice guidelines and supporting literature. The 72 patient scenarios and 10 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. A separate, multidisciplinary Voting Panel made up of specialists and nonspecialists rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2018, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians. Key recommendations include the concept that interventions should be goal oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique oriented (immobilization). This evidence-based, goal-oriented approach does not support the immobilization of suspected spinal injuries via rigid collars or backboards.

The American Academy of Orthopaedic Surgeons has developed Appropriate Use Criteria (AUC) for Surgical Management of Osteoarthritis of the Knee. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The Surgical Management of Osteoarthritis of the Knee AUC clinical patient scenarios were derived from indications of patients under consideration for surgical treatment of osteoarthritis of the knee as well as from current evidence-based clinical practice guidelines and supporting literature to identify the appropriateness of the three treatments. The 864 patient scenarios and 3 treatments were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

These Appropriate Use Criteria (AUC) for the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures are based on a review of the available literature regarding the management of patients with orthopaedic implants undergoing dental procedures1 as well as a list of clinical patient scenarios constructed by an expert Writing Panel and voted on by a separate multidisciplinary Voting Panel. The AUC development methods are adapted from the RAND/UCLA Appropriateness Method (RAM)2. The full Appropriate Use Criteria for the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures, with the Appropriate Use Criteria tables, final appropriateness ratings, and a list of panel members, can be accessed on the AAOS web site at: http://www.aaos.org/auc. The AUC is also available as a web-based application; to access this application, please visit http://www.orthoguidelines.org/auc. Members of the Writing Panel developed a list of 64 patient scenarios regarding the management of patients with orthopaedic implants based on the identified patient indications (Table I) and defined sub-classifications along with 1 treatment (Table II), for a total of 64 antibiotic prophylaxis voting items (64 scenarios × 1 treatment) (Tables I and II). View this table: TABLE I Patient Indications and Sub-Classifications View this table: TABLE II List of Treatments Rated for Appropriateness* …

Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the Appropriate Use Criteria (AUC) document Treatment of Hip Fractures in the Elderly to improve patient care and obtain optimal outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The AUC clinical patient scenarios were derived from indications typical of patients commonly presenting with hip fractures in clinical practice, as well as from current evidence-based clinical practice guidelines and supporting literature. The 30 patient scenarios and 6 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. A separate, multidisciplinary Voting Panel made up of specialists and nonspecialists rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

In an effort to produce best practice guidelines for spine immobilization in the austere environment, the Wilderness Medical Society convened an expert panel charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in an austere (dangerous or compromised) environment. Recommendations are made regarding several parameters related to spinal immobilization. These recommendations are graded on the basis of the quality of supporting evidence and balance between the benefits and risks or burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians. A treatment algorithm based on the guidelines is presented. This is an updated version of original WMS Practice Guidelines for Spine Immobilization in the Austere Environment published in Wilderness & Environmental Medicine 2013;24(3):241–252.

mTOR inhibitors are emerging as important anti-neoplastic agents with a wide range of clinical applications. The topoisomerase I inhibitor irinotecan is a potent DNA damaging drug, with a broad spectrum of anticancer activities. mTOR appears to enhance cancer cell survival following DNA damage, thus the inhibition of mTOR after irinotecan could theoretically show synergistic activities in patients. Both mTOR inhibitors and irinotecan have been used as single agents in soft tissue sarcomas with limited efficacy. We completed a phase I trial of the combination of the mTOR inhibitor, temsirolimus, and irinotecan in patients with advanced soft tissue sarcoma. Seventeen patients were recruited. The Phase II recommended dose is 20 mg of temsirolimus and 80 mg/m2 of irinotecan administered on weekly basis for three out of four weeks. Most frequently encountered toxicities include cytopenias, fatigue, and gastrointestinal toxicities. Two patients (one with leiomyosarcoma and one with high grade undifferentiated sarcoma) had stable disease for more than 12 months.

Orthopaedic surgeons traditionally have been trained with use of an apprenticeship model, with experience being measured on the basis of case log documentation and with competency being determined by senior mentors. Over the past decade, medical education has undergone a major paradigm shift, with increasing emphasis on teaching toward competence as a specialist, including operative skills, essential knowledge for practice, professionalism, and the use of evaluation methods thought to be credible, accurate, reproducible, and transparent. The primary use of an apprenticeship model may result in graduates never having performed some procedures or never having managed patients with certain diagnoses. Alternatively, the competency model may result in graduates performing well on certain standard procedures but perhaps not demonstrating competency on relatively rare entities. While the provision and assessment of medical education have become more complex in proportion to advanced technologies and novel procedures, delivering excellence in education itself has become increasingly difficult as a result of duty-hour restrictions, …

These Appropriate Use Criteria (AUC) for the Management of Hip Fractures in the Elderly are based on a review of the available literature regarding the treatment of hip fractures in the elderly and the postoperative rehabilitation of low-energy hip fractures in the elderly1, as well as a list of clinical patient scenarios constructed by an expert Writing Panel and voted on by a separate multidisciplinary Voting Panel. For the purposes of these AUC, “elderly” is defined as 60 years of age and older. The AUC development methods are adapted from the RAND/UCLA Appropriateness Method (RAM)2. The full Appropriate Use Criteria for the Management of Hip Fractures in the Elderly with the Appropriate Use Criteria tables, final appropriateness ratings, and a list of panel members, can be accessed on the AAOS website at: http://www.aaos.org/Quality/Appropriate\_Use\_Criteria\_(AUC)/Appropriate\_Use_Criteria/. The Hip Fracture AUC are also available as a web-based application; to access this application, please visit http://www.orthoguidelines.org/auc or download the OrthoGuidelines app from Google Play or the Apple Store. Members of the Writing Panel developed a list of 30 patient scenarios regarding hip fracture treatment and 72 patient scenarios regarding postoperative rehabilitation based …

These Appropriate Use Criteria (AUC) for the Management of Anterior Cruciate Ligament (ACL) Injuries are based on a review of the available literature regarding the treatment and prevention of ACL injuries1 as well as a list of clinical patient scenarios constructed by an expert Writing Panel and voted on by a separate multidisciplinary Voting Panel. The AUC development methods are adapted from the RAND/UCLA Appropriateness Method (RAM)2. The full Appropriate Use Criteria for the Management of Anterior Cruciate Ligament Injuries, along with the Appropriate Use Criteria tables, final appropriateness ratings, and a list of panel members, can be accessed on the AAOS website at http://www.aaos.org/auc. The ACL AUC is also available as a web-based application; to access this application, please visit http://www.orthoguidelines.org/auc. Members of the Writing Panel developed a list of fifty-six patient scenarios regarding ACL injury treatment and forty-eight patient scenarios regarding ACL injury prevention based on the identified patient indications (Tables I and II) and defined subclassifications along with six treatments and one prevention intervention (Tables III and IV), for a total of 352 ACL injury treatment voting items and forty-eight …

Summary: Metastatic disease to the pelvis and lower extremity is a significant contributor to morbidity in patients with metastatic cancer. When indicated, surgical prevention of pathologic fractures and treatment of established fractures can preserve patient mobility, dramatically increase pain control, and prevent associated co-morbidities. Forty percent of bony metastases occur in the pelvis and 25% in the femur. Because of the limited life expectancy and debilitated nature of patients undergoing palliative surgery for metastatic disease, the surgical construct should allow immediate unrestricted weight bearing. All areas of the bone should be imaged and all significantly involved portions of the bone should be addressed with the reconstruction. Postoperative radiation therapy should be considered. With appropriate technique and implant selection, outcomes of surgical management are generally very good.

Summary: Proximal tibia resection with endoprosthetic reconstruction is a complex limb sparing procedure for tumors of the proximal tibia. Recent advances in implants and surgical techniques have made this option preferable to amputation for many patients. Long-term survival and recurrence rates are similar between limb salvage and limb ablation in the proximal tibia. Appropriate indications for limb salvage are imperative to mitigate disastrous outcomes such as loss of limb or life. A comprehensive perioperative evaluation should include a detailed history and physical, laboratory, and radiographic testing, along with a biopsy confirmed diagnosis before the definitive procedure. Once a patient has been appropriately evaluated, there are three steps critical to a successful procedure: proximal tibia resection, reconstruction of the proximal tibia and knee joint with a prosthetic component, and extensor mechanism reconstruction utilizing a gastrocnemius flap to improve implant coverage and enhance the patellar tendon repair. Proximal tibia resection with prosthetic reconstruction can be associated with significant complications; however, these can be minimized with appropriate preoperative planning and a meticulous technique.

The differential diagnosis of a fractured clavicle includes acute traumatic fracture, stress fracture, pathologic fracture secondary to radiation exposure, neoplasm, infection, or metabolic bone disease, and fracture-like conditions such as infection and bony dysplasias. An appropriate workup should identify most of these underlying conditions. We report a case of concurrent bilateral nontraumatic fractures of the clavicle occurring in a healthy young man in the absence of repetitive trauma. Workup revealed no underlying explanation for the fractures. To our knowledge, this has not been reported. Our case suggests the differential diagnosis of a fractured clavicle should be expanded to include idiopathic nontraumatic fractures.

This is a review of Medline and PubMed articles on open fractures published in the English literature between 1945 and April 2005. The emphasis of most published articles has been placed on definitive treatment of these injuries at sophisticated referral hospitals. The prehospital emphasis has been on rapid evacuation and referral to ensure that definitive treatment can be initiated as quickly as possible. Little has been discussed about the management of these injuries in remote settings where evacuation may consume considerably more time. Contemporary recommendations for management of these injuries are reviewed.

An observational cohort study was performed on 90 hip arthroplasties performed in 84 patients for metastatic disease of the hip. Significant improvement was noted with both 3-month and 6-month function scores vs preoperative function scores (P < .001). Complications included 1 intraoperative femur fracture, 2 cases of deep venous thrombosis, 1 peroneal nerve palsy, 1 deep infection, and 5 dislocations. Eight (8.8% of 90 procedures, 9.4% of 84 patients) patients died during the initial hospital stay. Although the risk of mortality after hip arthroplasty for metastatic diseases is perhaps higher than previously expected, improvement in postoperative function scores in surviving patients was significant and perioperative morbidity in this complex patient population was acceptably low.

Two children presented with painful lytic lesions in the lower extremity. The lesions were located within cortical bone, and surrounded by sclerosis of the medullary bone and periosteal new bone formation. The lesions were painful, and nonsteroidal anti-inflammatory agents relieved the pain. CT-guided core biopsies were performed followed by radiofrequency treatment. Pathologic evaluation of the specimens revealed features consistent with benign intracortical chondroma. In one case radiofrequency treatment appears to have cured the tumor. The other patient required operative intervention.

Twenty-seven patients developed infection following bulk allograft transplantation and were treated with resection of the allograft, placement of an antibioticimpregnated polymethylmethacrylate (PMMA) spacer, and intravenous antibiotics. Overall, the infection was eradicated in 14 (52%) of 27 patients. Of the 11 patients who did not undergo allograft reimplantation, 5 underwent amputations for persistent infection in the presence of the spacer and 4 had a retained spacer at most recent follow-up. No significant correlation was noted between successful eradication of the infection and age, sex, diagnosis, adjuvant therapy, acute or chronic infection, number of operative procedures, type of allograft procedure, duration of antibiotics, or type of organism. Although deep infection of allograft transplantations continues to result in a high rate of failure, this method of management results in successful limb salvage in almost half of the patients.

Metastatic bone disease has a significant effect on a patient's mortality and health-related quality of life. An aging US population and improved survival rates of patients with cancer have led to an increase in the incidence of symptomatic bony metastatic lesions that may require orthopaedic care. Skeletal-related events in neoplastic disease include pain, pathologic fracture, hypercalcemia, and neural compression, including spinal cord compression. The clinical evaluation and diagnostic study of a patient with a skeletal lesion of unknown etiology should be approached carefully. In patients with widespread metastatic disease, the treatment of a skeletal-related event may be limited to stabilization of the pathologic fracture or local disease control. The treatment of metastatic bone disease is guided by the nature of the skeletal-related event, the responsiveness of the lesion to adjuvant care, and the overall condition and survival expectations of the patient. Impending pathologic fractures are often more easily treated, with less morbidity and easier recovery for patients, than completed fractures. Quality of life is the most important outcome measure in these patients. When surgery is indicated, the approach, choice of fixation, and use of adjuvant should allow for immediate and unrestricted weight bearing. Because metastatic lesions to the skeleton have a limited capacity for spontaneous healing, surgical fixation should be durable for the life expectancy of the patient. In the epiphyseal region of long bones, replacement arthroplasty is generally preferred over internal fixation. Metaphyseal and diaphyseal regions can generally be addressed with intramedullary nailing or plate fixation with adjuvant. The specific treatment of acetabular lesions is dictated by the anatomy and the degree of bone loss. Spinal stability and neural compromise are important considerations in choosing a strategy for managing spine tumors. Effective surgical approaches to metastatic disease of the spine may include vertebral augmentation or open decompression and realignment of the spinal column with internal fixation. Radiation therapy is an important adjunctive modality in the treatment of metastatic bone disease. Medical management consists of symptom control, cytotoxic chemotherapy, and targeted therapy. Emerging technologies, including radiofrequency ablation, cementoplasty, and advances in intraoperative imaging and navigation, show promise in the treatment of metastatic bone disease.

In an effort to produce best-practice guidelines for spine immobilization in the austere environment, the Wilderness Medical Society convened an expert panel charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in an austere (dangerous or compromised) environment. Recommendations are made regarding several factors related to spinal immobilization. These recommendations are graded based on the quality of supporting evidence and balance between the benefits and risks or burdens for each factor according to the methodology stipulated by the American College of Chest Physicians. A treatment algorithm based on the guidelines is presented.

The benefit of preliminary traction in the treatment of developmental dislocation of the hip has not been clearly demonstrated. We retrospectively analyzed the results of traction treatment of 90 dislocated hips in 72 patients. After a 3-week course of traction, patients underwent attempted closed reduction. Fifty-two hips (58%) were managed successfully by closed reduction, whereas 38 hips (42%) required primary open reduction. chi 2 analysis revealed no significant difference in either the rate of successful closed reduction or the incidence of avascular necrosis compared to recently published series in which preliminary traction was not used. On the basis of presentation radiographs and arthrograms, we were unable to identify a subgroup of patients that clearly benefited from the use of traction in the treatment of developmental dislocation of the hip.

Background To assess the response of patients with soft tissue sarcoma (STS) to the combination of docetaxel, bevacizumab, and gemcitabine. Vascular endothelial growth factor (VEGF)-A levels and expression of VEGF-A and VEGF receptors 1 and 2 were evaluated. Patients and methods Thirty-eight chemotherapy-naive patients with STS were enrolled. A dose-finding study for gemcitabine from 1000, 1250, then 1500 mg/m2 was done in nine patients (three cohorts), followed by an expansion cohort of 27 patients. Dose of docetaxel was 50 mg/m2, bevacizumab was 5 mg/kg, and gemcitabine was 1500 mg/m2, every 2 weeks. Serum VEGF-A was measured by enzyme-linked immunosorbent assay and tissue VEGF-A and its receptors by immunohistochemistry. Results The median follow-up was 36 months. The overall response rate observed was 31.4%, with 5 complete and 6 partial responses, and 18 stable diseases lasting for a median of 6 months. There was no significant hematologic toxicity. The adverse events with the highest grade were attributed to bevacizumab. There was no correlation of VEGF pathway biomarkers with outcome. Conclusions The combination of gemcitabine, docetaxel, and bevacizumab is safe and effective in patients with STS. The most concerning adverse events were consequences of bevacizumab administration. The benefit of bevacizumab in this patient population remains unclear.

Suboptimal patient management can occur when malignant soft tissue tumors with internal hemorrhage masquerade as simple hematomas. We retrospectively reviewed 31 patients with malignancies who had diagnostic delays averaging 6.7 months (range, 1.0-49.3 months). The diagnoses included soft tissue sarcomas (27), metastatic cancers (three), and lymphoma (one). History of subcutaneous ecchymosis was positive in only five patients (three of whom had trauma), negative in 18, and unknown in eight. Ecchymosis was present in two patients, absent in 20, and unknown in nine. Previous treatments included observation and reassurance (21), aspiration (11), incision and drainage (10), unplanned resections (seven), physical therapy (seven), medication administration (six), and arthroscopy (one). Interpretations of initial MRI (21) and ultrasound (four) did not raise suspicion of underlying cancers. Traumatic hemorrhage usually causes subcutaneous ecchymosis. However, intratumoral hemorrhage often is contained by a pseudocapsule, which prevents fascial plane tracking and subcutaneous ecchymosis, thus providing a diagnostic clue. Magnetic resonance imaging and ultrasound studies may not accurately diagnose questionable lesions. Diagnostic delay or inappropriate treatment may result if patients do not receive appropriate followup, biopsy (usually open), or referral whenever the diagnosis is in doubt.

Beginning in 2007, there was substantial movement from the American Academy of Orthopaedic Surgeons (AAOS) and the American Orthopaedic Association (AOA) to promote a coordinated match process for orthopaedic fellowships. It is estimated that at least 90% of all orthopaedic surgery residents participate in a year of fellowship training1. The results of a survey at the 2007 AOA Symposium on Fellowships found that 79% of attendees believed that the current process was unacceptable and 87% believed that the process was unfair to residents2. The situation of those disciplines that were not in an organized match process was compared with problems often seen in a decentralized labor market2. A survey of residents indicated that 80% of residents were in favor of an organized match for fellowship and wanted a later date in their fourth postgraduate year for the decisions2. The problems of the fellowship process at that time were obvious, with no formal match process. There were multiple subspecialties competing and applicants were asked to commit to a position as early as their third postgraduate year, sometimes without full exposure to all subspecialties. In some instances, residents were forced to accept or decline an offer, during or shortly after an interview. This did not allow the resident to have an opportunity to compare programs. The benefits of a fellowship match include optimal consideration of all options by both the applicant and the program. The purpose of this article is to review the history of the fellowship match process, to report on four years (2010 to 2013) of the formalized orthopaedic fellowship match process, and to provide information for applicants, residency, and fellowship programs on the match. Specifically, we will report on the information accumulated regarding fellowship applications and positions, as well as data …

Met behulp van kwalitatieve en kwantitatieve analyse van het looppatroon evalueerden wij bij 41 patienten met degeneratieve arthritis de gevolgen van een totale heupartroplastiek (tha). Patienten met unilaterale en bilaterale degeneratieve heupaandoeningen werden geevalueerd, met als doel het benoemen van de kenmerken van het preoperatieve

10027 Background: Topoisomerase I inhibitors have some activity in refractory sarcomas, such as rhabdomyosarcoma and other round cell tumors, with responses between 70-20% depending on the histolog...

• Compartment syndrome is a rare but serious complication of vascular reconstruction. It most commonly occurs following revascularization of an acutely ischemic extremity. This case of compartmental syndrome following bypass surgery for chronic arterial insufficiency is therefore exceedingly unusual. A review of the literature reveals only a few cases with similar presentation. The diagnosis can usually be made on the basis of clinical manifestations combined with compartmental pressure measurement. A timely, four-compartment fasciotomy can avert serious complications with minimal morbidity. Late recognition and treatment of this complication, as well as inadequate decompression, can lead to loss of limb. (Arch Surg. 1992;127:865-866)

10534 Background: The combination of G and D has efficacy against refractory STS (Hensley, JCO 2002). Poor prognosis STS have a high content of VEGF. This phase I/II study assesses the safety and e...

• Forty-four surgical mastectomy specimens obtained during resection of carcinoma of the breast were evaluated for involvement of the nipple and/or areola by cancer. Such involvement was found in 11 specimens (25%). Tumor size, relative distance of the tumor from the nipple, and tumor histologic type were investigated and compared with nipple-areolar involvement. The high incidence of nipple involvement found here indicates a definite risk of recurrence for surgical procedures that preserve the nipple. ( Arch Surg 1981;116:1139-1140)