| 1. |
- Lunsjö, Karl, et al.
(författare)
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Extramedullary fixation of 569 unstable intertrochanteric fractures: a randomized multicenter trial of the Medoff sliding plate versus three other screw-plate systems
- 2001
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 72, s. 133-
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Tidskriftsartikel (refereegranskat)abstract
- We compared the efficacy of the Medoff sliding plate (MSP) with 3 other screw-plate systems for fixation of unstable intertrochanteric fractures in a randomized multicenter trial of 569 elderly patients. The MSP has biaxial dynamic capacity along both the neck and the shaft of the femur unlike the other systems, which lack dynamic capacity along the shaft. 268 fractures were operated on with the MSP, and 301 with the dynamic hip screw (DHS), with or without a trochanteric stabilizing plate (DHS/TSP) or with the dynamic condylar screw (DCS). The MSP had recently been shown to the surgeons.The patients in the groups were similar as regards age, domestic situation, preinjury walking ability and type of fracture. We followed the patients clinically and radiographically for at least 1 year. There was no significant difference in walking ability at follow-up or rate of return to home. Fixation failure occurred in 18/268 fractures operated on with the MSP, in 8/238 with the DHS, in 3/49 with the DHS/TSP and in 1/14 with the DCS. The difference in the rate of fixation failure was not statistically significant when the MSP group was compared to the 3 other groups. In 14 of the 18 fixation failures in the MSP group, the biaxial dynamic capacity of the MSP had not been used due to technical errors by surgeons, unfamiliar with the new method. No selection bias was found regarding fracture types in the 2 subgroups of patients with correct or inadequate biaxial dynamization. Extramedullary fixation of unstable intertrochanteric fractures with these implants showed a low failure rate. When using the MSP, biaxial dynamization must be correctly performed.
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| 2. |
- Skytting, Björn
(författare)
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Synovial sarcoma : a Scandinavian sarcoma group project
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Synovial sarcoma accounts for 5 to 10 % of all soft tissue sarcomas. More than 90 % are found in the extremities or trunk wall. Characteristic for synovial sarcoma is the translocation t(X; 18) (p11.2;q11.2). Cloning of the breakpoints of this translocation revealed fusion of two novel genes, SYT and SSX. The SYT gene, located on chromosome 18, is fused with one of three closely related genes; SSX1, SSX2 or SSX4 located on the X chromosome. The long term survival rates have continuously improved and have at best been reported to around 50 %. However, since almost no population based studies on synovial sarcoma have been reported, these improvements may be due to differences in patient selection due to a changes in referral practice. This project was based on a consecutive series of synovial sarcoma patients from the Scandinavian Sarcoma Group Register acquired during a 9-year period. Only surgically treated patients without metastases at diagnosis were included in the prognostic analyses. The tumors were defined clinically, histopathologically, molecular and cytogenetically and these features were related to clinical course. 34 of 104 patients developed metastases. The overall 5 and 7 years survival rates were 0.76 (95% CI 0.66-0.83) and 0.69 (0.58-0.78), respectively. Large tumor size and amputation were significantly associated with impaired metastasis free survival. In addition, patients with local recurrence had a higher risk for metastases following the local event. Histologically, all were high grade lesions, 74 Grade III and 30 IV. Kaplan-Meier estimates of metastasis-free survival at 5 years were 83% (95% CI 72-92%) for patients with Grade III tumors versus 31% (95% CI 13-5 1%) for Grade IV. Histologic grading conveyed more prognostic information than any single histologic factor. Immunostaining with anti-Ki-67 antibodies (MIB1) and p53 based on formalin-fixed paraffinembedded material from 86 patients revealed that MIB1 > 10% was associated with poorer metastasis-free survival but p53 was not. Type of fusion transcripts (SYT-SSX1 or SYT-SSX2) and Ki-67 were assessed in fresh frozen tissue from 33 patients. The 5-year metastasis-free survival for patients with SYT-SSX1 was 42% versus 89% for those with SYT-SSX2. The hazard ratio for metastasis associated with the SYT-SSX1 fusion transcripts was 7 (95% CI 1.5-36, log-rank P=0.004). There was a significant association between SYT-SSX1 and high tumor proliferation rate. Comparative Genomic Hybridization revealed DNA sequence copy number changes in 35 of 69 tumor specimens. The frequency of aberrations/ tumor were higher in monophasic tumors than in biphasic. Gains of chromosome 8 were associated with large tumors (>5 cm). There was no obvious association between secondary aberrations and clinical outcome. In conclusion, large tumor size, local recurrence, histologic Grade IV, MIB1 index > 10 and possibly SYT-SSX1 fusion transcript were associated with impaired clinical outcome.
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| 3. |
- Skytting, Björn T., et al.
(författare)
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Clinical course in synovial sarcoma : A Scandinavian sarcoma group study of 104 patients
- 1999
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 70:6, s. 536-542
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Tidskriftsartikel (refereegranskat)abstract
- We analyzed treatment and outcome in 104 Scandinavian patients with synovial sarcoma in the extremities or trunk wall, diagnosed between 1986 and 1994. Only surgically treated patients without metastases at diagnosis were included. Median follow-up of survivors was 6 (3-11) years. 34 patients developed metastases. The overall 5- and 7-year survival rates were 0.76 (95% Cl 0.66-0.83) and 0.69 (0.58-0.78), respectively. Large tumor size and amputation were significantly associated with impaired metastasis-free survival. Patients with local recurrence had a higher risk of metastases following the local event. Local excision with inadequate margin was associated with a higher risk of local recurrence.
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