Publications by authors named "Olavo Pires DE Camargo"

59 Publications

ONE-YEAR RESULTS OF BRACING FOR PATELLO-FEMORAL OSTEOARTHRITIS. PROSPECTIVE RANDOMIZED STUDY.

Acta Ortop Bras 2021 May-Jun;29(3):127-131

Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, HC-FMUSP, São Paulo, SP, Brazil.

Objective: To compare the long-term effects of a brace designed to stabilize the patellofemoral (PF) joint in comparison to a standard neoprene sleeve for the knee with patellar hole in patients with patellofemoral osteoarthritis (PFOA).

Methods: 38 patients with PFOA and comorbidities received either a functional PF brace (Study Group, SG) or a neoprene sleeve for the knee (Control Group, CG). Both groups received clinical treatment to OA and comorbidities according to a program from the institution. Patients were evaluated with Western Ontario and MacMaster (WOMAC) and Lequesne questionnaires, 30-second chair stand test (30CST), Timed Up and Go (TUG), anthropometric measures and self-reported physical activity in minutes/week at inclusion, one, three and twelve months after placing the brace. X-Rays were taken to measure the angles.

Results: At one year there was more abandonment in the CG without differences in weight and body mass index between groups during the study. The SG maintained improvements in Lequesne and WOMAC total and subsets during the year, whereas the CG returned to baseline values for pain, function and total (p < 0.01). TUG and 30CST results were always better in the study group without any clinically important improvement in both groups.

Conclusion: Long-term use of functional brace added to self-management program improves pain and function in patients with PFOA
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http://dx.doi.org/10.1590/1413-785220212903243598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8266283PMC
September 2020

IMPROVEMENT OF METRICS.

Acta Ortop Bras 2021 May-Jun;29(3):117

Universidade de São Paulo, Medical School, Orthopedics and Traumatology Department (DOT-FMUSP), São Paulo, SP, Brazil.

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http://dx.doi.org/10.1590/1413-785220212903117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8266279PMC
July 2021

Clinical impact of brachyury expression in Ewing sarcoma patients.

Adv Med Sci 2021 Jul 14;66(2):321-325. Epub 2021 Jul 14.

Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga, Guimarães, Portugal; Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil.

Purpose: The T-box transcription factor brachyury has been demonstrated as a prognostic factor in a variety of cancer types and considered a novel oncotarget in solid tumors. Brachyury acts as a regulator of the epithelial-mesenchymal transition (EMT) process, leading to more aggressive behavior and poorer prognosis. However, recent literature evidence suggests a tumor suppressor role in other neoplasms. In the present study, we aimed to study brachyury expression and its prognostic impact in Ewing sarcoma, an aggressive neoplasm of young individuals.

Methods: We analyzed the expression of brachyury by immunohistochemistry in a series of 96 Ewing sarcomas in a tissue microarray and investigated the association of the protein expression with the clinical parameters and overall survival.

Results: More than half of the cases (51%, n ​= ​49) depicted positive nuclear brachyury expression, while a lack of expression was observed in 49% (n ​= ​47) of cases. Nuclear brachyury staining was significantly associated with non-white ethnicity (p ​= ​0.04) and axial localization (p ​= ​0.025). Importantly, lack of brachyury expression was significantly associated with lower overall survival in multivariate analyses (hazard ratio - HR: 2.227, p ​= ​0.008).

Conclusions: Our findings indicate, that brachyury is an independent prognostic biomarker in Ewing sarcoma, which might suggest a tumor suppressor role and which yet to be fully elucidated.
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http://dx.doi.org/10.1016/j.advms.2021.06.002DOI Listing
July 2021

IMPROVEMENTS IN HIP OSTEOARTHRITIS WITH LAVAGE, TRIAMCINOLONE AND HYLAN G-F20.

Acta Ortop Bras 2020 Nov-Dec;28(6):280-286

Universidade de São Paulo, Hospital das Clínicas, Medical School, Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil.

Objective: To verify whether the use of Hylan G-F20 improves saline lavage and triamcinolone injection results in the treatment of hip osteoarthritis (HOA).

Methods: 82 patients with HOA categorized as grades II and III severity, according to Kellgren and Lawrence criteria, were randomized into the groups: lavage and triamcinolone (G0); lavage, triamcinolone, and 2 mL of hylan G-F20 (G1); lavage, triamcinolone, and 4mL of hylan G-F20 (G2); lavage, triamcinolone, and 6mL of hylan G-F20 (G3). The VAS, range of motion (ROM), WOMAC, and Lequesne questionnaires were administered at baseline, one, three, six, and twelve months post-injection.

Results: All groups showed clinically relevant improvements (> 20%) between baseline and first month post-injection, maintaining subjective results throughout the study period (p < 0.001). We found no differences between groups in any subjective evaluations (p > 0.05, for all). G2 and G3 obtained improved flexion results up to a year (p = 0.028). Hylan groups presented an improved external rotation since the first postoperative month and maintained the results up to a year (G1, p = 0.041; G2, p = 0.007), whereas G0 showed no improvement (p = 0.336).

Conclusion: Hip lavage and triamcinolone injection, with or without the use of hylan, improves pain, function, and quality of life up to a year in HOA. Hylan may improve ROM up to one year.
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http://dx.doi.org/10.1590/1413-785220202806240075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723387PMC
December 2020

THE GROWTH IN SCIENTIFIC PRODUCTION.

Acta Ortop Bras 2020 Sep-Oct;28(5):211

Universidade de São Paulo, Medical School, Orthopedics and Traumatology Department (DOT-FMUSP), São Paulo, SP, Brazil.

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http://dx.doi.org/10.1590/1413-785220202805011223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7580298PMC
November 2020

ARTHROSCOPIC TREATMENT FOR LATERAL EPICONDYLITIS: OUTCOMES IN 104 CASES OF A SINGLE INSTITUTION.

Acta Ortop Bras 2019 May-Jun;27(3):156-159

Universidade de São Paulo, Faculdade de Medicina, Orthopedics and Traumatology Department, São Paulo, SP, Brazil.

Objective: To evaluate the outcomes of patients that underwent arthroscopic surgery for lateral epicondylitis (LE), after failed conservative treatment.

Methods: One hundred four patients with LE treated with arthroscopic debridement of the extensor carpi radialis brevis (ECRB) tendon were enrolled in this retrospective study. They were evaluated using Disabilities of the Arm, Shoulder and Hand (DASH) score, Visual Analogue Scale (VAS) and Short Form Health Survey (SF-36) scale. Mean age at surgery was 46.9 years. Duration of symptoms was 2.1 years (range: 6 m to 10 yrs.). Mean follow-up was 34.4 months (range: 6 to 68 m).

Results: Mean postoperative scores were: 20.67 points on the DASH; 1.8 points on the VAS at rest, with 48 cases (46%) without pain, 40 (38%) with mild pain, 13 (13%) with moderate pain and 4 (4%) with severe pain; 4.7 points on the VAS in activity, with 21 (20%) without pain, 21 (20%) with mild pain, 35 (34%) with moderate pain and 27 (26%) with severe pain; and SF-36 was 66.8 points. Of the 23 patients who practiced sports regularly or with higher physical demand from the upper limbs, 17 (74%) were able to return to the same activity at the same level. No significant complications were observed postoperatively, except for 3 (2.8%) cases of postoperative superficial infection.

Conclusion: Surgical treatment with arthroscopy for recalcitrant LE is effective and safe, presenting positive outcomes in the studied patients.
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http://dx.doi.org/10.1590/1413-785220192703216249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699394PMC
August 2019

PRIMARY LEIOMYOSARCOMA OF BONE: CLINICOPATHOLOGIC AND PROGNOSTIC FACTORS ANALYSIS IN A SINGLE INSTITUTION.

Acta Ortop Bras 2019 May-Jun;27(3):152-155

Universidade de São Paulo, Faculdade de Medicina, Orthopedics and Traumatology Department, São Paulo, SP, Brazil.

Objective: Primary leiomyosarcoma of bone (PLB) is a rare type of malignant bone tumor considered as a variant of the spindle cell sarcomas (SCS). The objective of this study was to analyze the clinicopathologic and the prognostic factors of patients with PLB treated at a single institution.

Methods: We retrospectively reviewed the records of 22 patients with pathologically confirmed PLB. The data collected were: age, sex, tumor size and location, grade and stage of the disease and histopathologic features. Mean age was 45.5 years (range, 17 to 73 y). Location was: upper limb (27.3%), lower limb (68.2%) and pelvis (4.5%). Patients had high grade in 90.9% of the reports. Margins were negative in 77.3% of the cases. Histological reports describe spindly sarcomatous cells arranged in fascicles with increased vascular formation without osteoid or chondroid matrix production. On immunohistochemistry, smooth muscle actin and desmin where positive in all cases.

Results: Mean follow-up time was 73.5 months (range, 5.3 to 331.1 m). We found 22.7% of local recurrence (LR). Distant metastasis (DM) was reported in 9 (40.9%) patients. Lung metastasis was the only DM affected site. Overall survival (OS) rate in 5 years was 59.1%. Predictors of OS were LR and DM.

Conclusions: PLB is an extremely rare malignant bone tumor that has a higher rate of DM and similar OS prognosis compared with other bone sarcomas.
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http://dx.doi.org/10.1590/1413-785220192703215676DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699396PMC
August 2019

PROFILE OF PATIENTS WITH OSTEOPOROTIC FRACTURES AND FACTORS THAT DECREASE PREVENTION.

Acta Ortop Bras 2019 Mar-Apr;27(2):95-99

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil.

Objective: To evaluate the epidemiological profile of patients with osteoporotic fractures compared to patients with osteoarthritis (OA) and identify factors that diminish adherence to secondary prevention.

Methods: A total of 108 patients with osteoporotic fractures (OF) were compared to 86 patients with OA.

Results: Patients in the OF group were older (p < 0.001); had a lower body mass index (p < 0.001); were less literate (p = 0.012); were more frequently Caucasian (p = 0.003); were less frequently married (p < 0.001); experienced more falls, cognitive deficiency, previous fractures, old fracture, falls in the last year, and fall fractures; needed more help and took more medicine for osteoporosis (p < 0.05); and showed less pathology in the feet, muscle weakness, less vitamin D intake, and lower Katz & Lawton scores (p < 0.001). Factors that increased the chance of nonadherence included older age (p = 0.020), falls (p = 0.035), cognitive deficiency (p = 0.044), and presence of depression/apathy/confusion (p < 0.001).

Conclusion: Patient age, ethnicity, marital status, previous falls, foot pathologies, muscle weakness, previous fractures, use of vitamin D, use of osteoporosis drugs, and lower Katz & Lawton scale score defined the OF group. Factors that increased the chance of nonadherence included older age, sedative use, cognitive disorders, and symptoms of depression/apathy/confusion.
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http://dx.doi.org/10.1590/1413-785220192702214727DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442712PMC
April 2019

ARTHROSCOPIC LATARJET TECHNIQUE COMBINED WITH ENDOBUTTONS: FUNCTIONAL OUTCOMES IN 26 CASES.

Acta Ortop Bras 2018 ;26(5):328-331

Universidade de São Paulo, Faculdade de Medicina, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil.

Objective: The cause of anterior shoulder instability is not fully understood and surgical management remains controversial. The objective of this study was to evaluate the results of patients undergoing arthroscopic Latarjet procedure with endobuttons.

Methods: A retrospective study of 26 patients undergoing arthroscopic Latarjet procedure with endobuttons to treat anterior shoulder instability. Patients with previous glenohumeral instability, failure of Bankart procedure or Instability Severity Index Score (ISIS) greater than or equal to 6, were included. Patients were assessed by: DASH, UCLA, Rowe, Visual Analog Scale (VAS) of pain and Short-Form 36 (SF36) scores. Correct position and consolidation of the graft were evaluated.

Results: Mean age was 31.5 years (16 to 46). Preoperative duration of symptoms was 1.7 years (1 month to 10 years). Mean follow-up was 14.3 (6 to 24) months. Mean postoperative scores were: 10 points in DASH; 1.6 in VAS, where 23 (88%) patients experienced mild pain and 3 (12%) moderate pain; 89 in Rowe; 32 in UCLA and 78 in SF-36. Positioning of the graft was correct in 25 (96%) cases, and was consolidated in 23 (88%). We had two cases of graft fracture (7%) and postoperative migration (7%).

Conclusion: Surgical treatment using arthroscopic Latarjet with endobuttons is safe and effective, producing good functional outcomes in patients.
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http://dx.doi.org/10.1590/1413-785220182605208650DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220660PMC
January 2018

PROGNOSTIC FACTORS IN PATIENTS WITH APPENDICULAR MYXOFIBROSARCOMA.

Acta Ortop Bras 2018 ;26(5):320-324

Universidade de São Paulo, Faculdade de Medicina, Orthopedics and Traumatology Institute, São Paulo, SP, Brazil.

Objective: Myxofibrosarcoma (MFS) is a common soft tissue sarcoma (STS) that affects the extremities in elderly patients. The objective was to analyze the prognostic factors and outcomes of patients with MFS treated at a single institution.

Methods: We retrospectively reviewed the records of 75 patients with MFS. We compared age, sex, tumor size and location, grade and stage of the disease. Median age was 49.7 years (range, 1 to 88 y).

Location: upper extremity (25.4%), lower extremity (66.6%) and pelvis (8%). Patients had high-grade tumors in 46.7% of the reports. Margins were negative in 76% of the cases. Bivariate Cox regression analysis was used to determine associations between clinical and treatment factors with local recurrence (LR).

Results: Median follow-up time was 30.7 months (range, 1.8 to 383.8 m). We found 26.7% of LR. Distant metastasis (DM) was reported in 27 (36%) patients. Lung was the most common site of DM, reported in 92.6% of patients. Overall survival (OS) with metastasis was 21.2 months (range, 4.8 to 114.8 m). Predictors of OS were grade, LR (hazard ratio [HR] 5.13, 95% confidence interval, 2.15-12.24, <0.001), and DM (HR 540.97, 95% confidence interval, 5.04-58112.03, 0.001).

Conclusions: Tumor grade, LR, positive margins and DM were significant predictors of poor OS prognosis.
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http://dx.doi.org/10.1590/1413-785220182605208644DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220657PMC
January 2018

Clinical and Structural Evaluations of Rotator Cuff Repair With and Without Added Platelet-Rich Plasma at 5-Year Follow-up: A Prospective Randomized Study.

Am J Sports Med 2018 11 20;46(13):3134-3141. Epub 2018 Sep 20.

Universidade de São Paulo, São Paulo, Brazil.

Background: Platelet-rich plasma (PRP) has been studied with the objective of reducing the retear rate and improving functional outcomes after rotator cuff repair. Only one study to date has reported its midterm effect.

Hypothesis: PRP promotes better functional and structural results in arthroscopic rotator cuff repair.

Study Design: Randomized controlled trial; Level of evidence, 2.

Methods: All patients underwent arthroscopic single-row repair of small to medium supraspinatus tears. At the end of the surgical procedure, liquid PRP prepared by apheresis with autologous thrombin was applied in the tendon-to-bone interface in the PRP group. The outcomes were assessed by the University of California, Los Angeles (UCLA) and Constant scales and the visual analog scale (VAS) for pain at 6, 12, 24, and 60 months after surgery and magnetic resonance imaging at 12 and 60 months.

Results: Of 54 patients initially randomized, we analyzed the clinical outcomes in 51 (25 control, 26 PRP) and the structural outcomes in 44 (22 each group). At 60-month follow-up, the mean UCLA scores were 32.5 ± 3.8 and 32.1 ± 4.6 in the control and PRP groups, respectively ( P = .992). The mean Constant scores were 82.0 ± 9.5 in the control group and 82.1 ± 11.0 in the PRP group ( P = .699). The mean VAS scores were 1.4 ± 1.8 and 1.5 ± 2.1 in the control and PRP groups, respectively ( P = .910). None of the clinical assessments at 6, 12, and 24 months in either group produced statistically significant differences, and both groups showed significant improvements throughout the follow-up time in the 3 evaluations ( P < .001). The control group exhibited 1 full-thickness retear (Sugaya type IV) and 11 partial-thickness retears (Sugaya type III), while the PRP group had 7 partial-thickness retears (Sugaya type III). The overall number of retears did not differ between groups ( P = .203).

Conclusion: PRP obtained by apheresis and applied in liquid form with the addition of thrombin at the end of single-row repair of supraspinatus tears did not promote better clinical or structural results at 60-month follow-up.

Registration: NCT01029574 ( ClinicalTrials.gov identifier).
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http://dx.doi.org/10.1177/0363546518795895DOI Listing
November 2018

TIBIAL ADAMANTINOMA: ANALYSIS OF SEVEN CONSECUTIVE CASES IN A SINGLE INSTITUTION.

Acta Ortop Bras 2018 ;26(4):252-254

Orthopedic Oncology Group, Instituto de Ortopedia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

Objective: Adamantinoma accounts for less than 1% of the primary bone neoplasms. The tibia is the most affected bone and it is predominant in male patients between the second and third decades of life. The objective of this study is to obtain epidemiological and clinical information on patients with adamantinoma of the tibia treated surgically between 1989 and 2016.

Methods: Retrospective series of seven patients diagnosed with adamantinoma of the tibia that underwent surgery at the orthopedic oncology service of our hospital. The information was obtained from the medical records and histopathological reports of our institution.

Results: A total of 2870 medical records with histological reports were evaluated. Seven cases of adamantinoma of the tibia were included. The mean age was 28.5 (17-49) years. We found a predominance of females (71.4%) and the most affected side was the left one, with four cases (57.1%). The biopsy revealed bone adamantinoma in four (57.1%) patients, while the diagnosis of the other patients was confirmed after the histological examination of the surgical specimen. All the patients underwent surgery as definitive treatment. No positive margins were reported. No local recurrence (LR) was reported and two patients had distant metastasis (DM).

Conclusion: The prognosis of survival in cases of adamantinoma of the tibia is high. The rates of LR and DM were low. Surgical treatment with extensive tumor resection is the treatment of choice.
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http://dx.doi.org/10.1590/1413-785220182604192680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6131285PMC
January 2018

EXTRA-ABDOMINAL DESMOID TUMOR: ANALYSIS OF 23 CONSECUTIVE CASES IN A SINGLE INSTITUTION.

Acta Ortop Bras 2018 ;26(4):244-247

Orthopedic Oncology Group, Instituto de Ortopedia e Traumatología, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

Objective: Extra-abdominal desmoid tumor (EDT) is a rare condition, caused by proliferation of fibroblasts. Despite being a benign tumor, it is locally aggressive and has unpredictable clinical behavior. The objective of this study is to present the clinical outcomes of patients with EDT treated surgically between 1995 and 2016.

Methods: This is a retrospective series of 23 patients with histopathological diagnosis of EDT that underwent surgery at the orthopedic oncology service of our hospital. The information was obtained from the institute's clinical and pathology reports.

Results: A total of 223 medical records with histopathological reports were evaluated. Only 23 cases of EDT were included in the present study. The mean age was 22.5 years. Twelve (52.2%) patients had the tumor on the lower limbs, seven (30.4%) on the upper limbs and four (17.4%) cases were reported on the back. Five (21.7%) patients had tumors measuring less than 5 cm, while eighteen (78.3%) patients had tumors measuring more than 5 cm. All patients underwent surgery as the definitive treatment in our institute. Twelve (52.2%) cases presented negative margins (NM) and eleven (47.8%) cases had positive margins (PM). Local recurrence (LR) occurred in eleven (47.8%) patients.

Conclusion: Impairment of the surgical margin was the only prognostic factor found for LR of EDT.
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http://dx.doi.org/10.1590/1413-785220182604192681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6131287PMC
January 2018

PERIPHERALLY INSERTED CENTRAL CATHETERS IN ORTHOPEDIC PATIENTS: EXPERIENCE FROM 1023 PROCEDURES.

Acta Ortop Bras 2018 May-Jun;26(3):206-210

. Orthopedic Oncology Group, Institute of Orthopedics and Traumatology, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

Objectives: The advantages of using a peripherally inserted central catheter (PICC) in hospitalized patients make this device very important for intravenous therapy. This study describes the use of PICCs at the Institute of Orthopedics and Traumatology at the Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo over the last 10 years.

Methods: This retrospective study analyzed 1,057 medical records and included 1,023 medical files with complete information on the punctured vein, diagnosis, duration of catheterization, complications, and catheter tip positioning.

Results: Seven hundred and twenty PICCs (70.4%) were considered successfully positioned, and mean duration of catheterization was 34.3 days. The basilic vein was used in 528 (51.6%) patients, while 157 (15.4%) catheters were removed due to complications. No cases of catheter-related thrombosis or infection were found. Eight hundred and sixty-six (84.6%) patients completed their treatment with PICC in place.

Conclusion: PICC is a safe intravenous device that can be successfully utilized for medium- and long-course intravenous therapy in hospitalized and discharged orthopedic patients.
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http://dx.doi.org/10.1590/1413-785220182603189368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053963PMC
July 2018

MEDIAL FEMORAL CONDYLE CORTICOPERIOSTEAL FLAP: ANATOMIC STUDY.

Acta Ortop Bras 2018 May-Jun;26(3):179-182

. Instituto de Ortopedia e Traumatologia, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

Objective: The medial femoral condyle corticoperiosteal flap is irrigated by the descending genicular artery, and when this is absent, by the superior medial genicular artery. The descending genicular artery divides into the muscular, saphenous, and osteoarticular branches. The objective of this study was to describe the variables involved in the dissection of the medial femoral condyle flap.

Methods: Thirty thighs from 20 cadavers were dissected and the following variables were recorded: age, height, weight, thigh length, presence of the descending genicular artery, whether the saphenous branch originated from the descending genicular artery, the length of the branches originating from the descending genicular artery, and the diameter of the descending genicular artery and the vena comitans.

Results: The descending genicular artery was present in 93.3% of the specimens (28/30). The saphenous branch originated from this artery in 76.7% of the dissections (23/70). The mean distance between the origin of the descending genicular artery and the knee joint was 13.4 cm (±١.4), the mean length of the descending genicular artery was 7.5 cm (±1.5), the mean diameter of the descending genicular artery was 1.9 mm (±٠.3), and the mean diameter of the vena comitans was 1.7 mm (±٠.3).

Conclusion: The vascularized medial femoral condyle is a versatile option for reconstruction of musculoskeletal injuries. It allows transference of bone associated with muscle and skin, which are each nourished by independent branches.
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http://dx.doi.org/10.1590/1413-785220182603190661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053957PMC
July 2018

PRIMARY BONE LYMPHOMAS: RETROSPECTIVE ANALYSIS OF 42 CONSECUTIVE CASES.

Acta Ortop Bras 2018 Mar-Apr;26(2):103-107

. Orthopedic Oncology Group, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

Objective: It is difficult to define parameters for management and factors associated with primary bone lymphoma (PBL). This article presents the experience in a single institution with 42 patients with PBL over a 16-year period (2000-2016).

Methods: Fifty-five patients were retrospectively evaluated, and forty-two were included (76.3%).

Results: Median age at diagnosis was 51.5 years, and median follow-up was 102.7 months. One patient had HIV. Pain in the affected site was the most prevalent symptom. The average time between symptom onset and diagnosis was 5.4 months. The vertebrae were most affected (n=16, 33.3%). According to the International Prognostic Index Score (IPI), 64.3% of the patients were classified as having low-grade lymphoma and 25.7% as low-intermediate. The most common histology was diffuse large B cell lymphoma (DLBCL) (85.7%). Immunophenotyping was CD20 positive in 93.5% of patients, and 11 patients had pathological fracture. All patients received chemotherapy and 30% of the regimens included rituximab. Thirty-eight percent of patients received radiation therapy. Overall survival was 50%, and survival median time was 80 months. Age and chemotherapy regimen influenced patient survival. Younger patients and patients who received RCHOP had better prognoses.

Conclusions: The choice of chemotherapy regimen associated with age influenced survival for patients with PBL. Level of Evidence IV; Case series.
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http://dx.doi.org/10.1590/1413-785220182602185549DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032620PMC
July 2018

SQUAMOUS CELL CARCINOMA IN THE FOOT: CASE SERIES AND LITERATURE REVIEW.

Acta Ortop Bras 2018 Mar-Apr;26(2):108-111

. Department of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.

Objectives: To report a case series of squamous cell carcinoma (SCC) in the foot, describing previous risk factors, surgical treatment, histopathological findings, and functional and oncological results.

Methods: Nine consecutive patients diagnosed with SCC of the foot were treated at a single institution and prospectively analyzed for risk factors related to the disease, surgical outcome, and histopathological, functional and oncological results. All patients had identifiable risk factors for SCC.

Results: Definitive treatment consisted of partial (6 patients) or total (3 patients) amputation of the foot. The functional score was good or excellent in the surviving patients. Early identifiable risk factors are present in most patients. Biopsy when this diagnosis is suspected, in association with oncological principles, avoids diagnostic and treatment errors.

Conclusion: Despite delayed diagnosis and surgical treatment with partial and total amputations of the foot in our series, we observed good oncological outcomes that avoided systemic spread of the disease and achieved expected functional results. Level of Evidence V; Case series.
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http://dx.doi.org/10.1590/1413-785220182602187183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962287PMC
May 2018

Novel animal model for Achilles tendinopathy: Controlled experimental study of serial injections of collagenase in rabbits.

PLoS One 2018 13;13(2):e0192769. Epub 2018 Feb 13.

Department of Orthopaedics and Traumatology, University of Sao Paulo (USP), School of Medicine, Sao Paulo, Sao Paulo, Brazil.

Our goal was to develop a novel technique for inducing Achilles tendinopathy in animal models which more accurately represents the progressive histological and biomechanical characteristic of chronic Achilles tendinopathy in humans. In this animal research study, forty-five rabbits were randomly assigned to three groups and given bilateral Achilles injections. Low dose (LD group) (n = 18) underwent a novel technique with three low-dose (0.1mg) injections of collagenase that were separated by two weeks, the high dose group (HD) (n = 18) underwent traditional single high-dose (0.3mg) injections, and the third group were controls (n = 9). Six rabbits were sacrificed from each experimental group (LD and HD) at 10, 12 and 16 weeks. Control animals were sacrificed after 16 weeks. Histological and biomechanical properties were then compared in all three groups. At 10 weeks, Bonar score and tendon cross sectional area was highest in HD group, with impaired biomechanical properties compared to LD group. At 12 weeks, Bonar score was higher in LD group, with similar biomechanical findings when compared to HD group. After 16 weeks, Bonar score was significantly increased for both LD group (11,8±2,28) and HD group (5,6±2,51), when compared to controls (2±0,76). LD group showed more pronounced histological and biomechanical findings, including cross sectional area of the tendon, Young's modulus, yield stress and ultimate tensile strength. In conclusion, Achilles tendinopathy in animal models that were induced by serial injections of low-dose collagenase showed more pronounced histological and biomechanical findings after 16 weeks than traditional techniques, mimicking better the progressive and chronic characteristic of the tendinopathy in humans.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192769PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5811024PMC
April 2018

Loss of MTAP expression is a negative prognostic marker in Ewing sarcoma family of tumors.

Biomark Med 2018 Jan 15;12(1):35-44. Epub 2017 Dec 15.

Institute of Orthopedics & Traumatology, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil.

Aim: The Ewing sarcoma family of tumors (ESFT) is a group of malignant small round cell neoplasms of bones and soft tissues closely histogenetically related. Methylthioadenosine phosphorylase (MTAP) deficiency has been recently associated with increased tumor aggressiveness and poor outcomes in different types of neoplasms. However, the expression of this biomarker and its biological role in ESFT remain largely unknown.

Methods: Immunohistochemical expression of MTAP was accessed in 112 patients with ESFT in a tissue microarray platform and associated with clinicopathological parameters and overall survival (OS).

Results: Loss of MTAP expression was significantly associated with lower OS in both univariate and multivariate analyses.

Conclusion: Loss of MTAP expression is an independent negative prognostic biomarker in ESFT.
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http://dx.doi.org/10.2217/bmm-2017-0152DOI Listing
January 2018

Objective functional results in patients with knee osteoarthritis submitted to a 2-day educational programme: a prospective randomised clinical trial.

BMJ Open Sport Exerc Med 2016 14;2(1):e000200. Epub 2017 Feb 14.

Department of Orthopaedics and Traumatology, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, Brazil.

Background: Although education is recommended for the treatment of knee osteoarthritis (KOA), its effectiveness in osteoarthritis (OA) remains low according to subjective questionnaires. The timed-up-and-go (TUG) and five-times-sit-to-stand tests (FTSST) reflect muscle strength and balance and could be used as objective measures of effectiveness.

Aim: To measure the effect of an educational programme in patients with KOA by TUG and FTSST and correlate these results to those of subjective questionnaires.

Methods: Prospective randomised controlled trial of patients with KOA. Participants (n=198) were allocated into four groups. Three groups participated in 2 days of lectures with 1 (group 1), 2 (group 2) and 3-month (group 3) intervals between classes. Group 4 had no classes. Participants were asked to exercise at least three times a week. Half of the patients from all groups received bimonthly telephone calls reinforcing diet and exercise instructions. All four groups received the printed and video material presented in the classes. At baseline and at 1 year after initial assessment, patients performed the FTSST and TUG and answered WOMAC, Lequesne, SF-36 and Visual Analogue Scale questionnaires.

Results: The TUG results did not change at 1 year follow-up, whereas FTSST improved (average difference of 4.66, p<0.001) irrespective of the implementation of classes or telephone calls. Both baseline and 1 year TUG and FTSST results correlated weakly (r<0.3) to the subjective functional, pain and quality of life results (p<0.001).

Conclusions: This educational programme improved function as determined by lower limb muscle strength (FTSST) irrespective of the patients' subjective non-improvement.

Trial Registration Number: Clinical trials registration number: NCT01572051.

Level Of Evidence: Level 1A.
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http://dx.doi.org/10.1136/bmjsem-2016-000200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569271PMC
February 2017

SERUM VALUES OF ALKALINE PHOSPHATASE AND LACTATE DEHYDROGENASE IN EWING'S SARCOMA.

Acta Ortop Bras 2016 Jul-Aug;24(4):196-199

. Universidade de São Paulo, Faculdade de Medicina, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil.

Objective: To study the relationship between the serum levels of alkaline phosphatase (AP) and lactate dehydrogenase (LDH), and the percentage of tumor necrosis (TN) in patients with Ewing´s Sarcoma (ES)

Methods: This is a case series with retrospective evaluation of patients with diagnosis of ES divided into 2 groups: Group 1, patients whose serum levels of alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) were obtained in the staging phase before preoperative chemotherapy (CT), and Group 2, patients whose values were measured after completion of the preoperative CT. The percentage of tumor necrosis (TN) of surgical specimens extracted in surgery was also evaluated

Results: Eighty four medical records from 1995 to 2015 were included. Both AP as LDH decreased in the patients studied, the pre CT value being higher than the post CT value. The average decrease of LHD was 272.95 U/L and AP was 10.17 U/L. The average tumor necrosis was 65.12 %. There was no statistical correlation between serums levels and the tumor necrosis percentage

Conclusion: The serum levels values of AP and LDH are not predictors for chemotherapy-induced necrosis in patients with ES.
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http://dx.doi.org/10.1590/1413-785220162404161312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035691PMC
March 2017

UNCEMENTED ARTHROPLASTY AFTER HIP METASTATIC DISEASE AND MULTIPLE MYELOMA.

Acta Ortop Bras 2016 Jul-Aug;24(4):191-195

. Universidade de São Paulo, Faculdade de Medicina, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil.

Objective: To describe a case series using a combination of narrative, graphical exploratory analysis and Bayesian Network modeling

Methods: Case series with 34 patients undergoing uncemented and hybrid arthroplasty procedures secondary to hip pain or fracture secondary to metastatic disease or multiple myeloma

Results: The most common tumors included gastrointestinal, multiple myeloma and breast cancer. Most devices were total arthroplasty (n = 16, 84.2%) rather than partial and uncemented arthroplasty (n = 12, 63.2%) rather than hybrid. The average time between surgery and deambulation was 20 days, the average length of hospital stay was 13 days, and the average patient survival was 589 days. Only one infection was reported. Uncemented and hybrid arthroplasty devices did not differ regarding time to walk, as well as the length of hospital stay in this sample

Conclusion: Our model may be used as a prior for the addition of subsequent patient samples, personalizing, thus, its recommendations to other patient populations.
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http://dx.doi.org/10.1590/1413-785220162404158362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035690PMC
March 2017

One-Year Results of an Educational Program on Osteoarthritis: A Prospective Randomized Controlled Trial in Brazil.

Geriatr Orthop Surg Rehabil 2016 Jun 11;7(2):86-94. Epub 2016 May 11.

Department of Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

Introduction: Knee osteoarthritis (KOA) is the most prevalent form of osteoarthritis. Low socioeconomic level, age, and obesity are directly correlated with the incidence of the disease. Education, exercise, and diet are the core recommendations of all KOA treatment guidelines.

Objective: To evaluate the impact of a multiprofessional educational program on patients with KOA.

Methods: Of a total of 198 participants, 150 patients with KOA attended 2 days of lectures (at 1- to 3-month intervals) and received educational material on osteoarthritis, and a control group (48 patients) received educational materials only. Body mass index (BMI), frequency, and intensity of physical activity, pain, function, and quality-of-life scores were assessed at baseline and at 4 and 12 months after the educational program. Bimonthly telephone calls were made to half of the participants. Correlations between BMI, level of education, coping skills, functional, and pain results was procured.

Results: The groups were similar in terms of race, gender, affected side, and osteoarthritis severity. The results were not affected by the telephone calls or the patients' level of education. At baseline, 25 performed physical activity, whereas 123 performed at 1 year. Seventy-two (36.36%) patients decreased BMI (45 by 1 point and 27 by more than 2 points). There were some weak correlations such as BMI reduction with pain and functional improvements and with coping results. Significant improvements in function and quality of life were found at 4 months. Quality of life remained improved at 1 year.

Conclusion: The effect of this educational program in function and quality of life of patients with KOA is very subtle. Interval between classes (1, 2, or 3 months) is not an important issue.
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http://dx.doi.org/10.1177/2151458516645634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872185PMC
June 2016

TUMORS OF THE PATELLA: THE EXPERIENCE OF INSTITUTE OF ORTHOPEDICS AND TRAUMATOLOGY AT UNIVERSITY OF SÃO PAULO, BRAZIL.

Acta Ortop Bras 2016 May-Jun;24(3):151-4

. Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil.

Objective: To obtain epidemiological data from the tumors of the patella diagnosed and treated at the Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Universidade de São Paulo (IOT-HC-FMUSP) between 1998 and 2015.

Methods: Series of cases with retrospective evaluation of patients diagnosed with tumors located in the patella. The data was obtained from the records and patients' charts at the Department of Pathology of IOT-HC-FMUSP.

Results: A total of 2220 medical records from patients with anatomopathological reports were included in the study. Only eight (0.3%) patients had patellar tumors. We found that six (75%) of these were benign, one (12.5%) was a pseudotumoral lesions and one (12.5%) was reported as malignant. Among benign tumors, the giant cell tumor (GCT) was the most frequently reported corresponding to 50% of the cases. Hemagioendothelioma was the only case of malignant tumor in this series. As for the pseudotumoral lesions, we found a brown tumor.

Conclusion: From the data obtained retrospectively in a 17 year time frame, in a service that treats benign, malignant and pseudotumoral bone lesions, we conclude that our casuistry in patellar tumors is similar to that reported in scientific literature, where benign tumors are predominant in a 7:1 ratio over malignant tumors, being a rare location of appearance, with the GCT as the most common diagnosis . Level of Evidence IV, Case Series.
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http://dx.doi.org/10.1590/1413-785220162403159158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863864PMC
July 2016

SERUM VALUES OF ALKALINE PHOSPHATASE AND LACTATE DEHYDROGENASE IN OSTEOSARCOMA.

Acta Ortop Bras 2016 May-Jun;24(3):142-6

. Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Ortopedia e Traumatologia, São Paulo, SP, Brazil.

Objective: To study the relationship between the pre and post chemotherapy (CT) serum levels of alkaline phosphatase (AP) and lactate dehydrogenase (LDH), and the percentage of tumor necrosis (TN) found in specimens after the pre surgical CT in patients with osteosarcoma.

Methods: Series of cases with retrospective evaluation of patients diagnosed with osteosarcoma. Participants were divided into two groups according to serum values of both enzymes. The values of AP and LDH were obtained before and after preoperative CT. The percentage of tumor necrosis (TN) of surgical specimens of each patient was also included.

Results: One hundred and thirty seven medical records were included from 1990 to 2013. Both the AP as LDH decreased in the patients studied, being the higher in pre CT than post CT. The average LHD decrease was 795.12U/L and AP decrease was 437.40 U/L. The average TN was 34.10 %. There was no statistically significant correlation between the serums values and the percentage of tumoral necrosis.

Conclusion: The serum levels values of AP and LDH are not good predictors for the chemotherapy-induced necrosis in patients with osteosarcoma. Level of Evidence IV, Case Series.
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http://dx.doi.org/10.1590/1413-785220162403157033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863862PMC
July 2016

Late failure of posterior fixation without bone fusion for vertebral metastases.

Acta Ortop Bras 2015 Nov-Dec;23(6):303-6

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Institute of Orthopedics and Traumatology, São Paulo, SP, Brazil.

Objective: : To verify the frequency of late radiological com-plications in spinal fixation surgeries performed without fu-sion in oncological patients.

Methods: : This is a retrospective analysis analysing failure in cases of non-fused vertebral fixation in an oncology reference hospital between 2009 and 2014. Failure was defined as implant loosening or bre-akage, as well as new angular or translation deformities.

Results: : One hundred and five cases were analyzed. The most common site of primary tumor was the breast and the most common place of metastasis was the thoracic spine. The average follow-up was 22.7 months. Nine cases (8%) of failure were reported, with an average time until failure of 9.5 months. The most common failure was implant loosening. No case required further surgery.

Conclusion: : The occurrence of failure was not different than that reported for fused cases. The time interval until failure was higher than the median of survival of the majority (88%) of cases. Level of Evidence IV, Therapeutic Study.
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http://dx.doi.org/10.1590/1413-785220152306151402DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4775506PMC
April 2016

Bioactive glass in cavitary bone defects: a comparative experimental study in rabbits.

Acta Ortop Bras 2015 Jul-Aug;23(4):202-7

Universidade de São Paulo, Faculdade de Medicina, Department of Orthopedics and Traumatology, São Paulo, SP, Brazil.

Objectives: To compare bioactive glass and autograft regarding their histomorphometric characteristics.

Methods: The authors conducted a prospective case-control experimental study on animals in order to compare the histomorphometric characteristics of bioactive glass versus autograft. Eight rabbits underwent surgery in which a cavitary defect was created in both proximal femurs. One side was filled with bioactive glass granules and the other, with autograft grafted from the contralateral side. The sides were randomized. Fourteen days after surgery, the animals were euthanized.

Results: Histologic analysis revealed that bone neoformation was equivalent among the two groups and the osteoblasts cell-count was higher in the femurs treated with bioactive glass. The osteocytes cell-count, however, was lower. The similarity in bone formation between both groups was consistent to literature findings.

Conclusion: Bioactive glass is similar to autograft regarding bone neoformation in this animal model of cavitary bone defects. Level of Evidence III, Case-Control Study.
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http://dx.doi.org/10.1590/1413-785220152304147538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544529PMC
September 2015

GCT: What happened after 10 years of curettage and cement? Retrospective study of 46 cases.

Acta Ortop Bras 2014 ;22(6):308-11

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil, Institute of Orthopedics and Traumatology of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brasil.

Objective: To compare the functional outcome of patients with and without arthrosis, and to determine whether the development of arthrosis is related to the distance of the tumor from the subchondral bone.

Methods: Forty six patients treated for Giant-cell tumor (GCT) between 1975 and 1999 met inclusion criteria. GCT was diagnosed by percutaneous biopsy and confirmed after resection, in all cases. Campanacci's and Kellgren's classification, the distance of the cement to the articular surface and MSTS score were obtained throughout the sample.

Results: The distance of the cement to the subchondral bone was associated with greater risk of developing arthrosis, but there was no difference in MSTS scores between patients with or without arthrosis.

Conclusion: We found that the distance from the cement to the subchondral bone has a prognostic value regarding future arthrosis, but it does not impact on the functional outcome. Level of Evidence IV, Therapeutic Study.
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http://dx.doi.org/10.1590/1413-78522014220600973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273955PMC
December 2014

Schooling of the patients and clinical application of questionnaires in osteoarthitis.

Acta Ortop Bras 2014 ;22(5):256-9

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.

Objective: To evaluate the consistency of the questionnaires (WOMAC, Lequesne, VAS, SF 36-PCS and SF 36-MCS) when applied in patients with osteoarthritis of the knees (KOA) verifying if age and level of education interfere with the completion of the questionnaires.

Method: One hundred and two patients with KOA answered WOMAC, LESQUESNE, VAS and SF-36 questionnaires and provided data correlated with age and education. The internal consistency of the WOMAC questionnaire was verified with Cronbach's alpha. Pearson's correlations between the questionnaires, age and educational level was performed.

Results: Mean age was 65 years old. Schooling averaged 7.94 years; WOMAC 47.95; VAS 63.57; Lequesne 12.29; PCS and MCS 31.91 43.68. Cronbach's alpha for WOMAC 0.9. Education did not affect WOMAC response (r=-0.182, p = 0.067) and MCS (r=0.021 / p=0.835), but showed weak but significant correlation with VAS (r=-0.264 / p=0.007), Lequesne (r=0.277, p=0.005) and PCS (r=0.309/ p=0.002). Age showed significant direct correlation only with PCS (r=0.205, p=0.039).

Conclusion: The level of education does not interfere with the completion of WOMAC but may interfere with completing VAS, Lequesne and physical component of SF-36. Level of Evidence II, Retrospective Study.
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http://dx.doi.org/10.1590/1413-78522014220500980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199642PMC
October 2014

Correlation between the expression of vegf and survival in osteosarcoma.

Acta Ortop Bras 2014 ;22(5):250-5

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil, Institute of Orthopedics, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.

Objective: To present a series of 50 consecutive patients with non-metastatic extremity osteosarcoma, and attempt to correlate expression of the vascular endothelial growth factor (VEGF) protein in biopsy tissue to their prognosis regarding overall survival, disease-free survival and local recurrence.

Methods: Fifty cases of non-metastatic osteosarcoma of the extremities treated between 1986 and 2006 at Instituto de Ortopedia e Traumatologia da Universidade de São Paulo, São Paulo, Brasil, were evaluated regarding expression of the VEGF protein. There were 19 females and 31 males. The mean age was 16 years old (range 5-28 years old) and the mean follow-up was 60.6 months (range 25-167 months). The variables studied were age, gender, anatomic location, type of surgery, surgical margins, tumor size, post chemotherapy necrosis, local recurrence, pulmonary metastasis and death.

Results: Thirty-six patients showed VEGF expression on 30% or less cells (low), and the remaining 14 cases had VEGF expression above 30% (high). Among the 36 patients with low VEGF expression, nine developed pulmonary metastasis and four died (11.1%). Among the 14 patients with high VEGF expression, six developed pulmonary metastasis and three died (21.4%).

Conclusion: There was no statistically significant correlation between the expression of VEGF and any of the variables studied. Level of Evidence IV, Therapeutic Study.
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http://dx.doi.org/10.1590/1413-78522014220500978DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199641PMC
December 2014
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