Besonderheiten und spezielle operative Behandlungsmöglichkeiten bei Skelettmetastasen des Hypernephroms

Therapy of pathological fractures of the femur caused by malignant tumours and skeletal metastases

“…In erster Linie findet sich diese Komplikation beim Plasmocytom [6,10,12,13,16,18,22,23]. Die prim/iren Knochenmalignome spielen daher als Ursache von pathologischen Femurfrakturen nur eine untergeordnete Rolle.…”

“…Wegen der Gefahr einer sekund/iren Perforation der Nagelenden unter Belastung [4,7,13,22] begrenzen wit dieses Operationsverfahren auf nicht mehr zu mobilisierende Patienten, bei denen eine bewegungsstabile Osteosynthese v611ig ausreicht. Die M6glichkeit einer Tumoraussaat beim Aufbohren der Markh6hle [14,15,23,25] stellt ffir uns keine Kontraindikation zur Marknagelung dar. Die M6glichkeit einer Tumoraussaat beim Aufbohren der Markh6hle [14,15,23,25] stellt ffir uns keine Kontraindikation zur Marknagelung dar.…”

Embolization of Pelvic Bone Metastases from Renal Cell Carcinoma

“…Because of the metastatic route through the cavai vein, métastasés are most frequently observed in the lung (9.5 % at the time of the diagnosis); the second most com mon site is found in bones (5.5% at the time of the diag nosis), followed by cerebral métastasés [11,12], Bone métastasés may cause pain, a palpable tumor or a spontaneous fracture. The presence of skeletal métas tasés can be accurately determined by radiographic stud ies, especially after previous bone scanning.…”

“…Considering the relatively high frequency of bone métastasés and such serious consequences as pain, restriction of mobility and confinement to bed, active therapy is necessary, although the prognosis is poor. The therapeutic possibilities con sist in: (1) removing the metastatic foci and replacing them by bone cement, plastic implants, endoprotheses or arthrodeses; (2) embolizing the vessels feeding the bone tumor, and (3) radiotherapy (controversial) [9,13].After surgical removal of the primary tumor, further treatment for skeletal métastasés should be considered [8,12], Embolization as the only therapy should be carried out in the following cases: (1) the foci are so extensive that complete removal is impossible; (2) the patient is still in a satisfactory state of health, and (3) other métas tasés have not yet been found.Embolization is of special interest when the osteolyses of the pelvic girdle cause loss of stability, and subsequent Methods Cyano-acrylate, which was diluted with Lipiodol (Byk Gulden) in a ratio between 1:1 and 1:6, was used for distal and permanent embolization; the material can be rendered more radiopaque by add ing a small amount of tantalum powder [2,7].As acrylate does not polymerize in a non-ionized medium, the blood has to be totally washed out of the catheter (no coaxial system); this is done with 40% dextrose [5]. The recommended dose of the acrylate mixture should not exceed 0.5-1.0 ml.…”