[Update on perioperative hypersensitivity reactions: joint document from the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part II: etiology and diagnosis].

This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment is extensive, the identification of medications, antiseptics and other substances used at each setting, the comprehensive data documentation, and the use of standardized nomenclature are key points for obtaining more consistent epidemiological information on perioperative anaphylaxis.

[Update on perioperative hypersensitivity reactions: joint document of the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part I: post-crisis guidelines and treatment].

Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis.

Formation of a physiological reverse shoulder joint.

Congenital shoulder deformities are rarely seen in orthopaedic practice. Proximal humeral defects and glenoid hypoplasia have been reported separately in the literature. We present a case involving a 31-year-old woman having a cosmetic problem with her upper arm who was diagnosed with reverse shoulder joint deformity.

CD8/FOXP3-ratio in osteosarcoma microenvironment separates survivors from non-survivors: a multicenter validated retrospective study.

Osteosarcoma is the most common primary bone tumor characterized by juvenile onset, tumor heterogeneity, and early pulmonary metastasis. Therapeutic improvement stagnates since more than two decades. Unlike major malignancies, biomarkers as prognostic factors at time of diagnosis are missing.

Anaphylaxis in Latin American children and adolescents: the Online Latin American Survey on Anaphylaxis (OLASA).

Objectives: To identify the main clinical manifestations, triggers, and treatment of severe allergic reactions (SAR) in children and adolescents (n=191, up to 18 years of age) seen by allergologists and registered in the Online Latin American Survey of Anaphylaxis (OLASA).

Results: 53.0% of the patients were males and the aetiological agent was identified in 85.

Anaphylaxis in Latin America: a report of the online Latin American survey on anaphylaxis (OLASA).

Objectives: The aims of the Online Latin American Survey of Anaphylaxis (OLASA) were to identify the main clinical manifestations, triggers, and treatments of severe allergic reactions in patients who were seen by allergists from July 2008 to June 2010 in 15 Latin American countries and Portugal (n =634).

Results: Of all patients, 68.5% were older than 18 years, 41.

Limb-salvage reconstruction with MUTARS hemipelvic endoprosthesis: a prospective multicenter study.

Background: Limb-sparing surgery with hemipelvic megaprosthetic replacement is often limited by the high rate of associated complications. The aim of this evaluation was to assess clinical and oncological findings with respect to type, treatment and outcome of post-operative complications.

Methods: First results of 40 patients treated with individual MUTARS hemipelvic endoprostheses were evaluated in a prospective multicenter study.

Methods of biological reconstruction for bone sarcoma: indications and limits.

Therapy of bone sarcoma has dramatically changed over the past few decades. Several successful interdisciplinary treatment strategies have led to an increase of the survival rates from 20% to 60%-80%. Consequently new demands on the operative treatment of bone and soft tissue sarcoma have arisen.

Effect of improved nasal airflow after adenoidectomy on nasal erectile tissue.

Objective: To determine the effect of improved nasopharyngeal airflow after adenoidectomy on nasal turbinate erectile tissue in pediatric patients.

Design: Clinical, prospective, before-and-after study.

Setting: Pediatric Otolaryngology Clinic at Hospital da Criança Santo Antônio de Porto Alegre (Complexo Hospitalar Santa Casa de Porto Alegre).

Local recurrence of giant cell tumor of bone after intralesional treatment with and without adjuvant therapy.

Background: The use of adjuvants after curettage has been well established for the treatment of giant cell tumor of bone. The purpose of this study was to analyze the rates of recurrence following different types of treatment as well as the influence of various factors of tumor presentation on those rates.

Methods: The data regarding benign giant cell tumors of the appendicular skeleton from ten bone tumor centers were evaluated.

[Reconstruction of phalanx and metacarpal defects by autologous iliac crest transplants after tumour resection with joint involvement].

Background: The reconstruction of large phalanx or metacarpal defects after tumour resection is still a challenge. In contrast to orthopaedic oncology there are no modular prostheses available in hand surgery. If the tumour affects the joint, often the only therapeutic option is an arthrodesis of the joint with a bone graft.

Prognostic significance of drug-regulated genes in high-grade osteosarcoma.

About 25-45% of patients with high-grade osteosarcoma poorly respond to chemotherapy with an increased risk of relapse and the development of metastasis. Therefore, the aim of this study was the evaluation of the prognostic value of eight previously identified drug-regulated candidate genes on osteosarcoma therapy outcome. Gene expression of 8 candidate genes was analyzed in 35 formalin-fixed, paraffin-embedded, laser-microdissected osteosarcoma biopsies.

The indication for gamma probe-guided surgery of spinal osteoid osteomas.

The standard treatment for osteoid osteomas is CT-guided radiofrequency ablation (RFA). This minimally invasive procedure is effective in terms of pain reduction as well as the recurrence rate. Nevertheless, the use for spinal lesions is limited due to a possible thermal damage of neural structures.

Preoperative elevation of serum C--reactive protein is predictive for prognosis in myeloma bone disease after surgery.

We investigated whether preoperative levels of serum C-reactive protein (CRP) and its correlation with tumour clinicopathological findings adds prognostic information beyond the time of diagnosis in patients with myeloma bone disease (MM) to facilitate the surgical decision-making process. Six hundred and fifty-eight myeloma patients were evaluated retrospectively for surgery. Clinicopathological variables of patients who underwent surgery (n=71) were compared between patients with preoperative CRP>or=6 mg l-1 and those with CRP<6 mg l-1.

Megaprostheses for the treatment of malignant bone tumours of the lower limbs.

Lower limb salvage surgery remains a challenge in orthopaedic oncology. Both cemented and cementless, modular, endoprosthetic systems are widely used to treat defects of different sizes. The systems have changed over the years, and each major orthopaedic company offers a modular tumour and revision system for the lower extremities.

[V.A.C.-instill therapy in periprosthetic infection of hip and knee arthroplasty].

Periprosthetic infection represents a main complication of arthroplasty. In case of an early infection the implant often can be left in place. Whether instillation of antiseptic solution using a reticulated sponge in combination with negative pressure wound therapy (V.

[An unusual complication after an insect bite? Diagnostic procedures in a case of granular cell tumor].

Granular cell tumors are, in almost all cases, benign soft tissue tumors, although malignant variants have rarely been described in a variety of anatomical locations. In the case presented here, a so-called atypical granular cell tumor was diagnosed based on two criteria, being differentiated from the usual histological findings by enhanced mitotic activity and focal spindle cell proliferation. Further suspicious characters of the tumor were its size of 13x10x5 cm on MRT as well as its long-term clinical course (1.

Intraoperative electron boost radiation followed by moderate doses of external beam radiotherapy in limb-sparing treatment of patients with extremity soft-tissue sarcoma.

Purpose: To analyze long-term prognosis and morbidity after limb-sparing treatment of patients with extremity soft-tissue sarcoma, with intraoperative electron boost radiotherapy (IOERT) followed by a moderate dose of external beam radiotherapy (EBRT).

Methods And Materials: A total of 153 patients who were treated in a single center from 1991 to 2004 were evaluated. Median IOERT dose was 15 Gy, mean EBRT dose 43 Gy (range, 40-50.

[Improving the diagnosis of septic arthritis by use of a pediatric blood culture system].

Background: Prognosis and outcome of bacterial joint infections are dependent on the fast and reliable identification of pathogens in the synovial fluid. Previous studies have suggested the possible advantage of using a blood culture system in contrast to conventional culture methods.

Patients And Methods: A total of 101 synovial specimens from patients presenting with symptoms suggesting septic arthritis were taken by aspiration with a sterile syringe.

Osteoid osteoma in an ex vivo animal model: temperature changes in surrounding soft tissue during CT-guided radiofrequency ablation.

Purpose: To assess temperature changes in the soft tissue surrounding bone during radiofrequency (RF) ablation of osteoid osteoma in an ex vivo animal model.

Materials And Methods: Intracortical cavities were created in fresh bovine long bone specimens obtained from a slaughterhouse as models for osteoid osteoma. Three groups of three specimens each were defined according to the thickness (1, 3, and 5 mm) of the cortical bone lamella separating the nidus from the periosteum.

Results of limb-sparing surgery with vascular replacement for soft tissue sarcoma in the lower extremity.

Objective: To evaluate limb-salvage surgery with vascular resection for lower extremity soft tissue sarcomas (STS) in adult patients and to classify blood vessel involvement.

Methods: Subjects were consecutive patients (median age, 56 years) who underwent vascular replacement during surgery of STS in the lower limb between January 1988 and December 2003. Blood vessel involvement by STS was classified as follows: type I, artery and vein; type II, artery only; type III, vein only; and type IV, neither artery nor vein (excluded from the analysis).

Rheumatoid arthritis and pigmented villonodular synovitis: comparative analysis of cell polyploidy, cell cycle phases and expression of macrophage and fibroblast markers in proliferating synovial cells.

Aims: Rheumatoid arthritis (RA) and pigmented villonodular synovitis (PVNS) are aggressive diseases with progressive joint destruction. The present study aims to define cell cycle phases, polyploidy and the immunophenotype of proliferating synovial cells in both diseases.

Methods And Results: Synovial tissues from patients with proliferative-active RA, localized and diffuse PVNS were analysed by DNA flow cytometry, immunohistochemistry and double immunofluorescence with confocal laser scan microscopy.

Osteosarcoma of the hand and forearm: experience of the Cooperative Osteosarcoma Study Group.

Background: Osteosarcoma is extremely rare in the hand and forearm. Therefore, only limited data are available for planning treatment or predicting the outcome and prognosis of osteosarcoma in the peripheral upper extremity.

Methods: Epidemiological, clinical, and histopathologic data were analyzed in 39 patients with osteosarcoma of the forearm or hand who were enrolled in studies of the Cooperative German-Austrian-Swiss Osteosarcoma Study Group from 1977 to December 2000.

Long-term survival after surgical intervention for bone disease in multiple myeloma.

Background: We describe the surgical treatment, outcome and long-term survival of patients with multiple myeloma (MM) in response to conventional (CC) or high-dose (HDT) chemotherapy.

Patients And Methods: Eighty-four patients diagnosed with MM were recruited for the study (51 male, 33 female; median age 62 years) and consecutively surgically treated in a single institution during a 12-year period. The main end point of the study was overall survival after surgery.

Ewing's sarcoma and primitive neuroectodermal tumor of hand and forearm. Experience of the Cooperative Ewing's Sarcoma Study Group.

Purpose: Because Ewing's sarcoma (EWS) is extremely rare in the hand and forearm, only limited data are available for planning treatment or predicting prognosis.

Methods: Data of 33 patients with EWS of the forearm or hand who were enrolled in studies of the German Association for Paediatric Oncology/Haematology and the European Intergroup Cooperative Ewing's Sarcoma Study Group were analyzed. Patients received neoadjuvant multi-agent chemotherapy according to the valid protocol.