Juan Luis Cebrian - Academia.edu (original) (raw)

Papers by Juan Luis Cebrian

Journal of Clinical Oncology, 2012

e20513 Background: Advanced STS have a dismal prognosis with a median overall survival of 1 year,... more e20513 Background: Advanced STS have a dismal prognosis with a median overall survival of 1 year, reported in most phase III clinical trials. Although newer targeted therapies are currently being evaluated, chemotherapy continues to be the mainstay of treatment. However, due to the limited activity of current treatments, new therapies are needed. Trabectedin, an alkylating agent to the minor groove of DNA, has demonstrated significant activity after failure of anthracyclines and ifosfamide. Methods: This is a retrospective analysis of 22 patients diagnosed with advanced, heavily pretreated STS, treated with trabectedin in a single institution. From 06/ 2000 to 06/ 2011, trabectedin was administered as a 3-hour infusion every 21 days at a dose of 1.1-1.5mg/m2 with steroid premedication. No patients were excluded from this analysis. Results: Median age was 53 years (range 21-82). The most frequent histologic subtypes were: 27% liposarcomas, 18% leiomyosarcomas, 13% malignant fibrous h...

Revista espanola de cirugia ortopedica y traumatologia, Jan 19, 2015

Vertebral fractures in oncology patients cause significant pain and disability, with decreased qu... more Vertebral fractures in oncology patients cause significant pain and disability, with decreased quality of life. The aim of the study is to assess the efficacy and safety of kyphoplasty in this type of vertebral fracture in the acute phase. A retrospective study was conducted on 75 consecutive oncology patients with 122 acute vertebral fractures, who underwent bilateral balloon kyphoplasty, with a mean follow up of 11 months. Almost all (91%) of the patients improved their pain level. The mean improvement in the Visual Analogue Scale (VAS) was 4.28 points (preoperative value 7.49 [SD 1.19], postoperative 3.21 [SD 0.95]). Before surgery, 53% of patients needed major opioids (40 cases), and one month after surgery only 12% (9 patients) required them. Quality of life determined by the Karnofsky index improved from 60.2 (SD 10) to 80.7 (SD 12.1). Cement leaks were found in 5.7% (7 cases), all without neurological repercussions. New fractures appeared in 11 patients. This subgroup showed ...

Journal of Biomedical Science and Engineering, 2014

Osteonecrosis of the femoral head is a disorder that leads to collapse and osteoarthritis in youn... more Osteonecrosis of the femoral head is a disorder that leads to collapse and osteoarthritis in young patients. This study examines the effectiveness of pulsed electromagnetic fields [PEMF] in the treatment of osteonecrosis of the head in precollapse bone stages. A retrospective evaluation was done of 51 patients including 70 hips with symptomatic osteonecrosis of the hip treated with pulsed electromagnetic fields. Criteria for inclusion in the study group were evidence of osteonecrosis and absence of collapse of the femoral head. The average follow-up was 26 months (range, 18-90). Etiologies included idiopathic (40 cases), steroid use (26) and alcohol (4). To demonstrate the existence of osteonecrosis and its evolution, magnetic resonance imaging [MRI] and plain radiography techniques were used. Results: Procedures were radiological success in 80% of cases, and no progression to collapse in 88.57% of hips. Eight of the 70 hips had radiographic progression to collapse. This study suggests that selected PEMF reduce the incidence of progression of osteonecrosis of femoral head in early stage.

International Orthopaedics, 2006

In this study we validated intraoperatively the analysis of polymorphonuclear leucocyte frozen se... more In this study we validated intraoperatively the analysis of polymorphonuclear leucocyte frozen sections for diagnosis of infection in hip and knee revisions. Between 1996 and 2002 we examined sections and cultured periprosthetic tissues in prosthetic revision in 170 cases, including 146 cases (83 hips and 63 knees). We assessed sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), Youden index, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). We compared intraoperative findings and paraffin-embedded samples. The results in the knee group were SE=66.7%, SP=89.7% [95% confidence interval (CI)], PPV=81% (95% CI), NPV=81.4% (95% CI), Youden index=0.56, PLR=6.5 (95% CI) and NLR=0.4 (95% CI). In the paraffinembedded samples the results were SE=91%, SP=87% (95% CI), PPV=81% (95% CI), NPV=94% (95% CI), PLR=7 (95% CI) and NLR=8.7 (95% CI). We found a significant difference. The results in the hip group were SE=50%, SP=100% (95% CI), PPV=100% (95% CI), NPV=94.9% (95% CI), Youden index=0.5 and PLR=0.5 (95% CI). In hip and knee prosthetic revision surgery the presence of polymorphonuclear cells correlates with infection, but their absence does not exclude it. It is a quick and inexpensive test that should be included in the diagnostic protocol in revision surgery. Level of evidence: diagnostic Study (investigating a diagnostic test), level I. See instructions to authors for a complete description of levels of evidence. Résumé Nous avons analysé des coupes de leucocytes polymorphonucléaires, prélevés per-opératoirement pour le diagnostic des infections de hanche et de genou lors des révisions prothétiques. Entre 1996 et 2002, nous avons examiné les coupes et les cultures des tissus périoprothétiques prélevés lors des révisions de prothèses (170 cas), 146 cas ont été inclus dans cette étude (83 hanches et 63 genoux). Nous avons évalué la sensibilité (SE), la spécificité (SP), la valeur prédictive positive (PPV), la valeur prédictive négative (NPV), l'index de Youden, le ratio positif de probabilité (PLR) et le ratio négatif de probabilité (NLR). Nous avons comparé les prélèvements per-opératoires et les échantillons inclus dans la paraffine. Résultats : Dans le groupe des genoux : SE=66,7%; SP=89,7% (CI 95%); PPV=81% (CI 95%); NPV=81,4% (CI 95%). L'index de Youden=0,56; PLR=6,5 (CI 95%); NLR=0,4 (CI 95%). Paraffine: SE=91%; SP=87% (CI 95%); PPV=81% (CI 95%); NPV=94% (CI 95%); PLR=7 (CI 95%); NLR=8,7 (CI 95%). Nous avons trouvé une différence significative. Dans le groupe de la hanche SE=50%; SP=100% (CI 95%); PPV=100% (CI 95%); NPV=94,9%) (CI 95%); l'index de Youden=0,5; PLR=0,5 (CI 95%). Conclusions: Dans la chirurgie de révision des prothèses de hanches et des prothèses de genoux, la présence de cellules polymorphonucléaires est bien corrélée avec l'infection, mais, son absence n'exclue pas celle-ci. Il s'agit là d'un test rapide, peu invasif qui peut être pratiqué systématiquement dans le protocole de ce diagnostic dans la chirurgie de révision articulaire.

International Orthopaedics, 2012

Purpose The optimal management of pyogenic discitis is not agreed on. We conducted a retrospectiv... more Purpose The optimal management of pyogenic discitis is not agreed on. We conducted a retrospective, cross-sectional, observational study in which all patients with discitis who attended Hospital San Carlos Madrid from January 1999 to January 2009 were included. Methods We identified 108 consecutive adult patients with infectious discitis. There were 49 men and 59 women with an average age of 67,5 (+/-16,89) years in the study group. Mean follow-up interval was 6,06 (12,5-2) years. 78 patients had spontaneous discitis and 30 patients had postoperative discitis. Inclusion criteria for the review were illness compatible with vertebral infection and / or evidence of spinal involvement on magnetic resonance imaging (MRI). Results In 56 percutaneous discal biopsy (52% patients) were positive in 28 cases. A single disc was infected in 100 patients. The segments involved were the cervical spine in four, the thoracic spine in 38 and the lumbar spine in 66. One or more comorbid diseases were present in 73 (68%) of 108 patients. Diabetes mellitus was the most common disease. Comorbid disease was rapidly fatal in four patients, ultimately fatal in seven patients, and nonfatal or not present in 97 patients (90 %). Conclusion Early diagnosis is a major challenge. Heightened awareness and the prompt use of MRI are necessary to avoid diagnostic delay. Prolonged antimicrobial therapy and the judicious application of timely surgical intervention are essential for an optimal outcome.

International Orthopaedics, 2009

We made a comparative cohort study in patients suffering from tibial pseudoarthrosis, all of whom... more We made a comparative cohort study in patients suffering from tibial pseudoarthrosis, all of whom were treated by intramedullary nailing. We divided patients into two groups: one treated by intramedullary nailing only (control group) and the other by intramedullary nailing combined with pulsed electromagnetic fields (PEMFs). The study included 57 cases of tibial pseudoarthrosis in 57 patients from February 1987 to February 2002. Pseudoarthrosis was treated surgically in all cases (Grosse-Kempf dynamic intramedullary nailing). This was combined with PEMFs in 22 cases. The average age was 38.3 years (range 14-89 years) and the average duration of follow-up was 27.2 months (range 12-48 months). Forty-nine fractures (86%) healed and eight (14%) did not. Of the group treated with PEMFs, 20 (91%) healed and two (9%) did not; from the group that did not receive PEMF (35), 29 (83%) healed compared to six (17%) that did not. The relationship between union and use of PEMFs, and between time to union and use of PEMFs was clinically relevant. PEMFs are useful when treating tibial pseudoarthrosis. Its noninvasive nature means that there are more complication-free unions.

Clinical Orthopaedics and Related Research, 2003

ing's sarcoma or its variant, peripheral primitive neuroectodermal tumor (PPNET). We describe the... more ing's sarcoma or its variant, peripheral primitive neuroectodermal tumor (PPNET). We describe the first case of PPNET arising from the seminal vesicle and outline the appropriate investigation and management. Case Report A previously well 26-year-old male presented with lower urinary tract symptoms (irritative) but urine culture yielded no pyuria or growth. His examination was unremarkable. Transabdominal ultrasound demonstrated a mass adjacent to the prostate which was confirmed on computed tomography (fig. 1). To further delineate the mass, an MRI scan was performed (fig. 2). At cystoscopy, the bladder mucosa was normal with an external mass protruding into the bladder lumen. Transrectal ultrasound and biopsy then demonstrated a PPNET on histology (fig. 3). Aggressive combined chemotherapy for six cycles was commenced (ifosfamide/etoposide/cyclophosphamide/adriamycin/vincristine). An initial positron emission tomography study displayed high uptake in the tumor but radioisotope activity was severely reduced after chemotherapy (fig. 4) so salvage excision of the tumor was undertaken. A lower midline abdominal incision was used as the surgical approach which remained extraperitoneal throughout. A standard retropubic radical prostatectomy was undertaken after careful lymph node sampling bilaterally up to the bifurcation of the common iliac vessels extending from and including the obturator fossa. Nerve sparing was undertaken as part of the radi

Case Reports in Oncology, 2021

The vast majority of patients with soft tissue sarcomas (STS) of the trunk and bilateral lung met... more The vast majority of patients with soft tissue sarcomas (STS) of the trunk and bilateral lung metastases at diagnosis are considered incurable. These tumors have poor prognosis as only a palliative therapeutic approach can be offered to patients. We report on an extremely rare case in which bilateral lung metastases disappeared spontaneously following surgical resection of the primary CIC-rearranged sarcoma with no addition of chemotherapy or any other systemic therapy. A 53-year-old female presented with a rapidly swelling mass on her back. A magnetic resonance imaging scan of the chest revealed a large soft tissue mass on the posterior chest wall and bilateral lung metastases. Soon after stereotactic core-needle biopsy confirmation of round-cell sarcoma, the patient underwent surgery of the primary tumor as it started to be increasingly symptomatic. The resected specimen was pathologically diagnosed a poorly differentiated grade 3 sarcoma. Approximately 1 month later, a new CT sca...

Surgery Case Reports, 2020

Background: Oncological femoral or pelvic resections and reconstruction have become an alternativ... more Background: Oncological femoral or pelvic resections and reconstruction have become an alternative to large amputations. However, one of the frequent risks is the neurological injury. The use of intraoperative evoked potentials allows its control in order to modify the surgical gestures. The purpose of this study was to evaluate the results of intraoperative neurophysiologic monitoring in large reconstructive arthroplasty surgeries. Case presentation: A prospective study (2012-2018) was performed, including 8 patients with 6 complete resections of the femur and 2 resections of the pelvis. In all cases, intraoperative lumbar plexus monitoring was performed using evoked potentials in order to analyze variations during surgery as well as a postoperative control. 100% could be correctly monitored throughout the surgery. In 4 cases, intraoperative anomalies were detected requiring modification of the surgery. Of these, postoperatively only one nerve injury persisted: a complete sciatic n...

International …, 2007

A retrospective clinical review was done on 54 revision hip patients. Radiological analysis exami... more A retrospective clinical review was done on 54 revision hip patients. Radiological analysis examined the Gross and AAOS classifications, stem position, cement mantles, allograft and evolution (subsidence, resorption and remodelling). The Harris Hip score was used for clinical assessment. We used bone bank allograft and a polished noncollared stem LD. The follow-up period was 60.5 months (19.4-152.4), and the average age 68.5 (range: 22-85). There were 21 females and 33 males. The surgical approach was: lateral (5.56%) posterior (91.4%); trochanteric osteotomy: 25.9%; associated acetabular revision: 59.3%; previous operations: 1.9. The preoperative Harris score was 35 (28-40) and rose to 81 (50-99) postoperatively. The stem alignment was neutral (44.44%), varus (38.89%) and valgus (16.67%). The femur/stem diameter relationship was 1.8 (1.2-2.7). There were no changes in stem alignment in 94.4%. An adequate cement mantle was: proximal zone (61.1%), medium zone (27.8%) and distal zone (16.7%). The rate of any subsidence was 38.9% (progressive: 12.96%). The rate of complications was 40.7% and included periprosthetic fracture: 14.

$Research paper thumbnail of Antegrade nailing for fractures of the distal femur$

Number 350 May, 1998 Antegrade Nailing of the Distal Femur 75 jng2i,23 and a decrease in the inci... more Number 350 May, 1998 Antegrade Nailing of the Distal Femur 75 jng2i,23 and a decrease in the incidence of in- fection.3,4'13-26«27'38 Its use in these type of frac- tures could bring with it breakage of the nail and varus ...