1/12. A staff dialogue on aggressive palliative treatment demanded by a terminally ill patient: psychosocial issues faced by patients, their families, and caregivers.Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery which provides hope to the patient, support to caregivers, and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum during which caregivers discuss a specific cancer patient, reflect on the important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from their fellow staff members. In this article, the case presentation and verbatim dialogue from the rounds are discussed with an emphasis on staff psychosocial issues. The case presented was of a 32-year-old man, who developed small cell osteosarcoma and was treated at MGH. He died after undergoing multiple courses of relatively ineffective chemotherapy. The case is made all the more poignant because of the pleasures, hopes and stresses of having a child late in the course of his illness. Staff identified closely, both with him and his family, and their concern for him brought joy and meaning to their work, yet this complicated their ability to deal with his impending death. They felt that his unwillingness to admit defeat prevented them from saying goodbye to someone whom they loved and admired. Despite this, staff recognized that, ultimately, the patient's emotional needs and wishes had to be respected as a first priority and that constructive closure can be worked toward, if not achieved. In such situations, it is vital to have a colleague support system and a forum for discussion of such issues in order to defuse distress and reassure staff that they are doing all that can be done as professionals and caregivers.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/12. Retreat from death?The case of Terry Jenkins, a 15-year-old boy, who was found to have a sarcoma of bone, was discussed on television under the title of 'Inside medicine'. The discussion revolved, not so much on the clinical details of the case or even of cancer of bone in a young person, as on the emotional disturbance that followed when the boy's mother refused to allow her son to be told about the nature of his illness or the proposed treatment. With hindsight, as is made clear in the discussion, the case should have been handled quite differently, with the general practitioner acting as the lynch pin and a psychiatrist and a social worker being brought into the emotional 'treatment' of the boy and his mother. As it was the boy was so disturbed about what he had guessed about his condition that he attempted suicide: fortunately he was rescued in time, and Terry is now stable, working, and mobile on his artificial leg.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
3/12. Compliant prestress fixation in tumor prostheses: interface retrieval data.This article reports the first available human retrieval data following the use of a new fixation system for tumor prostheses. The compliant prestress (CPS) fixation system obviates the need for long intramedullary stems. The CPS was designed to provide a stable, high-pressure, motion-free bone-implant interface that would prevent aseptic loosening and allow osseointegration at the bone-implant interface. At 10 months, the fourth patient in the human trial required amputation. Backscatter electron microscopy revealed a buttress of new bone had formed along 70% of the bone-metal interface, with excellent bony ingrowth (average: 42%) into the transverse, porous-coated titanium interface.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/12. Reconstruction of the proximal humerus with the clavicle after tumor resection: a case report.Reconstruction of the proximal humerus after resection for tumor and modification of the clavicular transposition procedure is described in which the blood supply of the clavicle is preserved and the clavicle is used to bridge the defect. An 11-year-old boy presented with shoulder pain, and the diagnosis was osteosarcoma of the right proximal humerus. After resection of the sarcomatous proximal humerus, the clavicle was released with its periosteum remaining intact, and the clavicle was rotated downward around the acromioclavicular joint. A vascularized fibula supplemented the reconstruction in trying to gain length of the arm. The acromioclavicular joint and the vascular supply of the clavicle were preserved. Internal fixation from the clavicle and the fibula to the distal humerus was made with an AO plate and screws. muscles around the proximal humerus were reattached to the clavicle. Range of motion of the shoulder was 80 degrees flexion, 85 degrees abduction, 30 degrees external rotation, and 90 degrees internal rotation. Although the postoperative followup is relatively short, only 2 years, the functional advantages of this operation over other forms of reconstruction can be observed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/12. aspergillus fumigatus infection in a mega prosthetic total knee arthroplasty: salvage by staged reimplantation with 5-year follow-up.Fungal infection after total joint arthroplasty is an extremely serious complication and a challenge to the treating physician. When a fungal infection is compounded by a massive allograft or a metallic segmental replacement of the femur or other long bone, treatment options become increasingly limited and commonly have led to arthrodesis or amputation of the infected limb. We present the first case report of a low-grade osteosarcoma treated with a segmental distal femoral allograft prosthetic composite knee arthroplasty, which was complicated by infection with aspergillus fumigatus. This complication was treated successfully with a staged reimplantation procedure, intravenous amphotericin, and oral fluconazole suppression. At 5 years after reimplantation, the patient has had no evidence of infection, no pain, and excellent range of motion without extensor lag. The Knee Society knee score improved from 50 to 100, and the function score improved from 40 to 100 (for both scores, 100 is the maximum).- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/12. Effect of myocutaneous inflammatory changes caused by intra-arterial chemotherapy on the outcome of patients who undergo limb-saving surgery.BACKGROUND: This study examined the effect of myocutaneous inflammatory changes caused by intra-arterial chemotherapy on the outcome of patients who undergo limb-saving surgery. methods: One hundred seven patients with malignant bone and soft tissue tumors were administered intra-arterial cisplatin and caffeine preoperatively with or without doxorubicin. Nine patients (8.4%) who had had myocutaneous inflammatory reactions were reviewed to determine the effects of this complication on limb-saving surgery. RESULTS: The patients complained of unbearable and continuous pain while undergoing intra-arterial infusion. gait disturbances and muscle weakness were caused by their severe regional pain, resulting in the use of crutches even before surgery. Extended areas of necrotic skin and muscle were resected simultaneously with limb-saving surgery on four patients. Myocutaneous necrosis in one patient, indurations in two patients, and flares in two patients were not treated surgically. Pain relief was provided to eight patients at some point. Four patients with extensive myocutaneous necrosis around the knee joint had restricted range of motion and poor functional results. radionuclide angiography using 99m-technetium-macroaggregated albumins was performed to evaluate the blood flow to the affected muscle and tumor. It showed marked increase of the radioisotope perfusion in the affected muscles but little uptake in the tumor. These results may suggest that the affected muscles diminish the effects of anticancer drugs on the tumors. CONCLUSIONS: Myocutaneous inflammatory reactions should be prevented if possible to obtain good limb function and chemotherapeutic effects in patients who undergo intra-arterial chemotherapy. Resection of necrotic tissue is mandatory to relieve pain.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/12. Clinical experience with psychological aspects in pediatric patients amputated for malignancies.AIMS AND BACKGROUND: amputation surgery in pediatric patients suffering from malignant tumors is less common than in the past, but has a great emotional impact on patients and their families as well as on the medical team. Studies addressing the psychological aspects of limb amputation in childhood cancer are still relatively limited, and the results have sometimes been contradictory. methods: At the Pediatric Oncology Unit of the Istituto Nazionale Tumori of Milan psychological support was provided to candidates for amputation and their families, involving medical oncologists, a clinical psychologist, and social assistants. Twenty-two patients were analyzed and 16 underwent mutilating surgery. RESULTS: Different emotional reactions were observed. Surgery proved to be easier to accept when the tumor caused pain and functional loss. Specialist medical psychological support was needed in case of defense mechanisms (eg, splitting and projection) and depressive reactions evolving into isolation or intolerance. CONCLUSIONS: The reported experience could be helpful in providing adequate support to children with tumors requiring mutilating surgery.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
8/12. Functional performance after tibial rotationplasty.We measured muscle strength, joint motion, and gait parameters and determined the electromyographic activities of the ankle and knee during walking, running, and stair-climbing in two children who had had a tibial rotationplasty for osteosarcoma of the distal end of the femur. Both had marked loss of strength in the plantar flexors on the side of the prosthesis compared with the sound side, although electromyographic recordings showed that the rotated calf muscles, to a substantial degree, had assumed the function of extensors of the prosthetic knee. Despite some abnormalities in gait, both children walked at speeds that were comparable to those of normal children. They could also run, climb stairs by stepping up with both limbs, and participate in many recreational activities. The functional abilities of these children suggested that rotationplasty, in patients with a similar lesion, is a worth-while alternative to above-the-knee amputation.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
9/12. The terminally ill patient on an acute psychiatric unit. A case study.1. As mental health professionals, we frequently fail to realize that we are subject to the same emotions and coping mechanisms as the lay community. 2. At times it seems safer to focus on a patient's medical condition than to deal with difficult, unresolved psychological issues. 3. By using existing resources within our institution, our interdisciplinary team faced many of their unresolved issues about death, such as countertransference, and were able to then help our patient through his final stage of life.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/12. Giant cell-rich osteosarcoma: a case report.This report discusses a rare case of giant cell-rich osteosarcoma. The patient, a 19-year-old male, was diagnosed with a metadiaphyseal osteolytic lesion when he consulted a local doctor complaining of motion pain without swelling. radiography revealed a geographic osteolytic lesion, cortical thinning and ballooning without obvious cortical destruction. However, a fine onion skin-like periosteal reaction was observed on the lateral side of the femur. The transitional none was narrow and endosteal scalloping was also noted. Needle biopsied material clearly showed nuclear atypism of the stromal tumor cells with numerous osteoclast-like giant cells. Using a combination of pathological examination, radiography, computed tomography (CT) and magnetic resonance imaging (MRI), a diagnosis of giant cell-rich osteosarcoma was reached. After chemotherapy, resection and limb salvage surgery with an autogeneous autoclaved bone graft, a vascularized fibular graft were performed, and the patient has shown excellent limb function without local recurrence or distant metastasis during the past 72 months.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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