Seventeen saddle prostheses were inserted between 1988 and 1997 after resection of periacetabular tumors. The tumors involved the zones II and III of Enneking classification in 13 patients, the zones I and II in 2 patients, and the zone II in 2 patients. The tumors included 11 chondrosarcomas, 3 Ewing sarcomas, 2 giant cells tumors, and 1 metastasis of renal carcinoma. The tumoral resection was wide "en bloc" in 14 cases, marginal in 2 cases, and intratumoral in 1 case. The mean follow-up period of the patients is 42 months ranging from 8 to 84 months. Local recurrences occurred in five cases and metastases in four cases. Five patients died of tumoral disease and one of intercurrent disease. Complications were observed in 11 cases (65%) including nerve damages (3 cases), deep infections (3 cases), upward migrations of the saddle (4 cases), saddle dislocations (3 cases), sacroiliac subluxations (2 cases), and mechanical failures (2 cases). The modified Musculoskeletal Tumor Society Score (MSTS) and the Toronto Extremity Salvage Score (TESS) were used for functional analysis. Functional results were available for only nine patients of the series with a mean MSTS of 17 points ranging from 11 to 23 points and a mean TESS of 58 points ranging from 39 to 95 points. The saddle prosthesis provided in all cases of this series an early painfree weight-bearing reconstruction with minimal limb shortening, but the functional results remained fair in most patients due to a limited range of motion and a poor abductor strength.

Summary. Twenty-nine patients with malignant giant-cell tumours of bone (GCT) were followedup for between 6 months and 18 years. Seventeen of the tumours were primary and 12 were due to malignant degeneration of initially benign lesions. The clinical features did not differ from those of benign GCT, except for a higher incidence in the distal tibia and sacrum. Anaplastic GCTs were included in the study because their clinical and radiographic features and prognosis were no different from those of the GCT grade III of Jaffe. Eighteen of the tumours were grade III, and 11 were anaplastic. This retrospective study was intended to assess the effects of chemotherapy and surgery for malignant GCT. Three treatment groups were selected, in which treatment was either by surgery alone, surgery plus chemotherapy, or radiotherapy alone. ± The prognosis was poor and the 5 year tumour-free survival rate in the series was 50%. The prognosis was the same for primary as for secondarily malignant tumours. There was no statistical difference in survival between malignant grade III and anaplastic malignant tumours. The one-year survival rate for patients treated by chemotherapy and surgery was statistically higher (chi 2 test) than for persons treated by surgery alone. However, the five-year survival rate and the actuarial survival curves were not statistically different in the two groups (log rank test). ± Chemotherapy appears to be of some value in the treatment of these malignant tumours but a larger series is required to confirm the efficacy of this approach.Re Âsume Â. Les auteurs rapportent vingt-neuf cas de tumeurs a Á cellules ge Âantes (TCG) malignes dont le suivi s'e Âtalait de 6 mois a Á 18 ans. Dix-sept e Âtaient malignes d'emble Âe et douze le sont devenues lors de la re Âcidive d'une TCG initialement be Ânigne. La clinique de ces tumeurs diffe Áre peu de celle des TCG be Ânignes, hormis la plus grande fre Âquences des localisations du tibia distal et du sacrum. Nous avons inclus dans cet e Âtude les TCG de Âdiffe Â-rencie Âes car leur aspect clinique, radiographique et leur pronostic est similaire aux TCG grade III, nous avions dix-huit TCG grade III et douze TCG de Âdiffe Ârencie Âes. Le but de cet travail e Âtait de tenter de mettre en e Âvidence l'inte Âre Ãt de la chimiothe Ârapie dans le traitement de ces tumeurs malignes, pour cela trois groupes de patients ont e Âte  e Âtudie Âs en fonction de leur traitement: chirurgie seule, chirurgie et chimiothe Ârapie, et radiothe Ârapie seule. Le pronostic de ces tumeurs est mauvais avec un taux de survie a Á 5 ans qui est de 50% dans notre se Ârie. Nous n'avons pas mis en e Âvidence de diffe Ârence statistiquement significative entre les TCG d'emble Âe malignes et celles devenues malignes secondairement, il n'y a pas non plus a diffe Ârence de survie entre les TCG grade III et les TCG de Âdiffe Ârencie Âes. Dans le groupe des patients traite Âs par chirurgie et chimiothe Ârapie, le taux de survie a Á un an est supe Ârieur a Á celui des autres groupes (test du chi 2 ), pa...

The present study evaluates the role of the inflammatory status and apoptosis activation in the development of organ dysfunction after brain death using plasma assays and macroarray analysis on skeletal muscle biopsies to look for evidence of remote tissue damage in two intensive care units in France and one in Belgium. As controls, we used patients undergoing hip surgery and healthy volunteers. Causes of brain death in the 85 consecutive patients included in the study were cardiac arrest (n = 29; 34%), stroke (n = 42; 49%, with 38 patients having hemorrhagic stroke), and head injury (n = 14; 17%). Of the 85 patients, 45 donated 117 organs. Plasma endotoxin and cytokine levels indicated a marked systemic inflammatory response in brain-dead patients, which was strongest in the cardiac arrest group. Leukocyte dysfunction, as assessed by cytokines production in response to various stimuli, was noted in a subgroup of patients with brain death after stroke. Interestingly, skeletal muscle biopsies showed no increase in mRNAs for genes related to inflammation, whereas mRNAs for both antiapoptotic and proapoptotic genes were increased, the balance being in favor of apoptosis induction. The increased activation of the proapoptotic caspase 9 was further confirmed by Western blot. In conclusion, the presence of inflammation and apoptosis induction may explain the rapid organ dysfunction seen after brain death. Both abnormalities may play a role in organ dysfunction associated with brain death. However, the level of systemic inflammation or the presence of circulating endotoxin was not associated with lower graft survival.

A 33-year-old man, right-handed, without epilepsy, was admitted to our department with a bilateral anterior shoulder dislocation sustained during a hypoglycemia-induced convulsion resulting from diabetes. The patient's shoulders appeared symmetric and "squared off" laterally. He had no neurological deficits or vascular injuries. Radiographs revealed bilateral anterior subglenoid dislocations, bilateral fractures of the greater tuberosity and bilateral non-displaced fractures of the tip of the coracoid process (Figures 1 and 2). Both dislocations were reduced under intravenous sedation. After reduction, radiographs and CT scan showed a good position of the fragments of the left shoulder (Figure 3), but a persistent anterior dislocation of the right humeral head associated with posterior displacement of the greater tuberosity ( Figure 4). The left shoulder was treated with a sling for 3 weeks, followed by rehabilitation. We performed an open reduction on the right shoulder using a delto-pectoral approach without section of the subscapularis muscle. The greater tuberosity was anatomically reduced and fixed by 2 cancellous screws, but the shoulder remained unstable because of a fracture of the anterior glenoid cavity. We performed an anterior osteoplastic ridge using the avulsed coracoid process fragment with its tendinous and muscular insertions. Postoperatively, the right shoulder was placed in a sling during 3 weeks. 7 months after surgery, the patient was able to work as a packer. On reexamination 2 years later, he had normal painfree active moveFigure 1. Frontal view of the right and left shoulders demonstrating bilateral anterior subglenoid dislocations associated with bilateral greater tuberosity fractures.