Discrimination of Basal Cell Carcinoma and Melanoma from Normal Skin Biopsies in Vitro Through Raman Spectroscopy and Principal Component Analysis

Objective: Raman spectroscopy has been employed to discriminate between malignant (basal cell carcinoma [BCC] and melanoma [MEL]) and normal (N) skin tissues in vitro, aimed at developing a method for cancer diagnosis. Background data: Raman spectroscopy is an analytical tool that could be used to diagnose skin cancer rapidly and noninvasively. Methods: Skin biopsy fragments of similar to 2 mm(2) from excisional surgeries were scanned through a Raman spectrometer (830 nm excitation wavelength, 50 to 200 mW of power, and 20 sec exposure time) coupled to a fiber optic Raman probe. Principal component analysis (PCA) and Euclidean distance were employed to develop a discrimination model to classify samples according to histopathology. In this model, we used a set of 145 spectra from N (30 spectra), BCC (96 spectra), and MEL (19 spectra) skin tissues. Results: We demonstrated that principal components (PCs) 1 to 4 accounted for 95.4% of all spectral variation. These PCs have been spectrally correlated to the biochemicals present in tissues, such as proteins, lipids, and melanin. The scores of PC2 and PC3 revealed statistically significant differences among N, BCC, and MEL (ANOVA, p < 0.05) and were used in the discrimination model. A total of 28 out of 30 spectra were correctly diagnosed as N, 93 out of 96 as BCC, and 13 out of 19 as MEL, with an overall accuracy of 92.4%. Conclusions: This discrimination model based on PCA and Euclidean distance could differentiate N from malignant (BCC and MEL) with high sensitivity and specificity.

Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: Analysis of 100 cases from a high-volume urologic center

OBJECTIVES: In this study, we aimed to determine the complications of standard surgical treatments among patients over 75 years in a high-volume urologic center. METHODS: We analyzed 100 consecutive patients older than 75 years who had undergone transurethral prostatic resection of the prostate or open prostatectomy for treatment of benign prostatic hyperplasia from January 2008 to March 2010. We analyzed patient age, prostate volume, prostate-specific antigen level, international prostatic symptom score, quality of life score, urinary retention, co-morbidities, surgical technique and satisfaction with treatment. RESULTS: Median age was 79 years. Forty-eight patients had undergone transurethral prostatic resection of the prostate, and 52 had undergone open prostatectomy. The median International Prostatic Symptom Score was 20, the median prostate volume was 83 g, 51% were using an indwelling bladder catheter, and the median prostate-specific antigen level was 5.0 ng/ml. The most common comorbidities were hypertension, diabetes and coronary disease. After a median follow-up period of 17 months, most patients were satisfied. Complications were present in 20% of cases. The most common urological complication was urethral stenosis, followed by bladder neck sclerosis, urinary fistula, late macroscopic hematuria and persistent urinary incontinence. The most common clinical complication was myocardial infarction, followed by acute renal failure requiring dialysis. Incidental carcinoma of the prostate was present in 6% of cases. One case had urothelial bladder cancer. CONCLUSIONS: Standard surgical treatments for benign prostatic hyperplasia are safe and satisfactory among the elderly. Complications are infrequent, and urethral stenosis is the most common. No clinical variable is associated with the occurrence of complications.

Gene expression down-regulation in CD90+ prostate tumor-associated stromal cells involves potential organ-specific genes

Abstract Background The prostate stroma is a key mediator of epithelial differentiation and development, and potentially plays a role in the initiation and progression of prostate cancer. The tumor-associated stroma is marked by increased expression of CD90/THY1. Isolation and characterization of these stromal cells could provide valuable insight into the biology of the tumor microenvironment. Methods Prostate CD90+ stromal fibromuscular cells from tumor specimens were isolated by cell-sorting and analyzed by DNA microarray. Dataset analysis was used to compare gene expression between histologically normal and tumor-associated stromal cells. For comparison, stromal cells were also isolated and analyzed from the urinary bladder. Results The tumor-associated stromal cells were found to have decreased expression of genes involved in smooth muscle differentiation, and those detected in prostate but not bladder. Other differential expression between the stromal cell types included that of the CXC-chemokine genes. Conclusion CD90+ prostate tumor-associated stromal cells differed from their normal counterpart in expression of multiple genes, some of which are potentially involved in organ development.

Tumor miofibroblástico inflamatório da bexiga em criança: relato de caso

Tumores miofibroblásticos inflamatórios raramente acometem vias urinárias ou crianças, comumente mimetizando neoplasias malignas nos exames de imagem. Foram descritos apenas 35 casos desses tumores na bexiga de crianças, segundo a literatura recente. Os autores apresentam o caso de uma criança com um tumor miofibroblástico vesical que evoluiu favoravelmente após ressecção cirúrgica completa.

The impact of atmospheric particulate matter on cancer incidence and mortality in the city of São Paulo, Brazil

This study aimed to verify the impact of inhalable particulate matter (PM10) on cancer incidence and mortality in the city of São Paulo, Brazil. Statistical techniques were used to investigate the relationship between PM10 on cancer incidence and mortality in selected districts. For some types of cancer (skin, lung, thyroid, larynx, and bladder) and some periods, the correlation coefficients ranged from 0.60 to 0.80 for incidence. Lung cancer mortality showed more correlations during the overall period. Spatial analysis showed that districts distant from the city center showed higher than expected relative risk, depending on the type of cancer. According to the study, urban PM10 can contribute to increased incidence of some cancers and may also contribute to increased cancer mortality. The results highlight the need to adopt measures to reduce atmospheric PM10 levels and the importance of their continuous monitoring.

Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: analysis of 100 cases from a high-volume urologic center

OBJECTIVES: In this study, we aimed to determine the complications of standard surgical treatments among patients over 75 years in a high-volume urologic center. METHODS: We analyzed 100 consecutive patients older than 75 years who had undergone transurethral prostatic resection of the prostate or open prostatectomy for treatment of benign prostatic hyperplasia from January 2008 to March 2010. We analyzed patient age, prostate volume, prostate-specific antigen level, international prostatic symptom score, quality of life score, urinary retention, co-morbidities, surgical technique and satisfaction with treatment. RESULTS: Median age was 79 years. Forty-eight patients had undergone transurethral prostatic resection of the prostate, and 52 had undergone open prostatectomy. The median International Prostatic Symptom Score was 20, the median prostate volume was 83 g, 51% were using an indwelling bladder catheter, and the median prostatespecific antigen level was 5.0 ng/ml. The most common comorbidities were hypertension, diabetes and coronary disease. After a median follow-up period of 17 months, most patients were satisfied. Complications were present in 20% of cases. The most common urological complication was urethral stenosis, followed by bladder neck sclerosis, urinary fistula, late macroscopic hematuria and persistent urinary incontinence. The most common clinical complication was myocardial infarction, followed by acute renal failure requiring dialysis. Incidental carcinoma of the prostate was present in 6% of cases. One case had urothelial bladder cancer. CONCLUSIONS: Standard surgical treatments for benign prostatic hyperplasia are safe and satisfactory among the elderly. Complications are infrequent, and urethral stenosis is the most common. No clinical variable is associated with the occurrence of complications.

The renin–angiotensin system plays a major role in voiding dysfunction of ovariectomized rats

Aims: The renin–angiotensin system (RAS) plays a major role in cardiovascular diseases in postmenopausal women, but little is known about its importance to lower urinary tract symptoms. In this study we have used the model of ovariectomized (OVX) estrogen-deficient rats to investigate the role of RAS in functional and molecular alterations in the urethra and bladder. Main methods: Responses to contractile and relaxant agents in isolated urethra and bladder, as well as cystometry were evaluated in 4-month OVX Sprague–Dawley rats. Angiotensin-converting enzyme activity and Western blotting for AT1/AT2 receptors were examined. Key findings: Cystometric evaluations in OVX rats showed increases in basal pressure, capacity and micturition frequency, as well as decreased voiding pressure. Angiotensin II and phenylephrine produced greater urethral contractions in OVX compared with Sham group. Carbachol-induced bladder contractions were significantly reduced in OVX group. Relaxations of urethra and bladder to sodium nitroprusside and BAY 41-2272 were unaffected by OVX. Angiotensin-converting enzyme activity was 2.6-fold greater (p < 0.05) in urethral tissue of OVX group,whereas enzyme activity in plasma and bladder remained unchanged. Expressions of AT1 and AT2 receptors in the urethra were markedly higher in OVX group. In bladder, AT1 receptors were not detected, whereas AT2 receptor expression was unchanged between groups. 17β-Estradiol replacement (0.1 mg/kg, weekly) or losartan (30 mg/kg/day) largely attenuated most of the alterations seen in OVX group. Significance: Prolonged estrogen deprivation leads to voiding dysfunction and urethral hypercontractility that are associated with increased ACE activity and up-regulation of angiotensin AT1/AT2 receptor in the urethral tissue.

Desarrollo embrionario y estudio morfométrico de la fase lecitotrófica de larvas de medregal negro (Seriola rivoliana Valenciennes, 1883)

[EN]The present study describes the main embryonic stages and larval development, in culture conditions, of the almaco jack until the fifth day of life. Also a morphometric study of the eggs and larvae from induced spawning was realized. Larval hatching occurred at 36 hours from fertilization. At 60 hours after hatching, 100% of the larvae had their mouths open. At 72 hours all the larvae had a swimming bladder and a digestive tract sufficiently formed to start exogenous feeding.

Mechanosensitivity in the myenteric plexus of the guinea pig ileum

The enteric nervous system regulates autonomously from the central nervous system all the reflex pathways that control blood flow, motility, water and electrolyte transport and acid secretion. The ability of the gut to function in isolation is one of the most intriguing phenomenons in neurogastroenterology. This requires coding of sensory stimuli by cells in the gut wall. Enteric neurons are prominent candidates to relay mechanosensitivity. Surprisingly, the identity of mechanosensitive neurons in the enteric nervous system as well as the appropriate stimulus modality is unknown despite the evidence that enteric neurons respond to sustained distension. Objectives: The aim of our study was to record from mechanosensitive neurons using physiological stimulus modalities. Identification of sensory neurons is of central importance to understand sensory transmission under normal conditions and in gut diseases associated with sensorimotor dysfunctions, such as Irritable Bowel Syndrome. Only then it will be possible to identify novel targets that help to normalise sensory functions. Methods: We used guinea-pig ileum myenteric plexus preparations and recorded responses of all neurons in a given ganglion with a fast neuroimaging technique based on voltage sensitive dyes. To evoke a mechanical response we used two different kinds of stimuli: firstly we applied a local mechanical distortion of the ganglion surface with von Frey hair. Secondarily we mimic the ganglia deformation during physiological movements of myenteric ganglia in a freely contracting ileal preparation. We were able to reliably and reproducibly mimic this distortion by intraganglionic injections of small volumes of oxygenated and buffered Krebs solution using stimulus parameters that correspond to single contractions. We also performed in every ganglion tested, electrical stimulations to evoke fast excitatory postsynaptic potentials. Immunohistochemistry reactions were done with antibodies against Calbindin and NeuN, considered markers for sensory neurons. Results: Recordings were performed in 46 ganglia from 31 guinea pigs. In every ganglion tested we found from 1 to 21 (from 3% to 62%) responding cells with a median value of 7 (24% of the total number of neurons). The response consisted of an almost instantaneous spike discharge that showed adaptation. The median value of the action potential frequency in the responding neurons was 2.0 Hz, with a recording time of 1255 ms. The spike discharge lasted for 302 ± 231 ms and occurred only during the initial deformation phase. During sustained deformation no spike discharge was observed. The response was reproducible and was a direct activation of the enteric neurons since it remained after synaptic blockade with hexamethonium or ω-conotoxin and after long time perfusion with capsaicin. Muscle tone appears not to be required for activation of mechanosensory neurons. Mechanosensory neurons showed a response to mechanical stimulation related to the stimulus strength. All mechanosensory neurons received fast synaptic inputs. There was no correlation between mechanosensitivity and Calbindin-IR and NeuN-IR (44% of mechanosensitive neurones Calb-IR-/NeuN-IR-). Conclusions: We identified mechanosensitive neurons in the myenteric plexus of the guinea pig ileum which responded to brief deformation. These cells appear to be rapidly accommodating neurons which respond to dynamic change. All mechanosensitive neurons received fast synaptic input suggesting that their activity can be highly modulated by other neurons and hence there is a low stimulus fidelity which allows adjusting the gain in a sensory network. Mechanosensitivity appears to be a common feature of many enteric neurons belonging to different functional classes. This supports the existence of multifunctional enteric neurons which may fulfil sensory, integrative and motor functions.

Immunohistochemical and Molecular Prognostic/Predictive Markers in Neoplastic Diseases

Traditional morphological examinations are not anymore sufficient for a complete evaluation of tumoral tissue and the use of neoplastic markers is of utmost importance. Neoplastic markers can be classified in: diagnostic, prognostic and predictive markers. Three markers were analyzed. 1) Insulin-like growth factor binding protein 2 (IGFBP2) was immunohistochemically examined in prostatic tissues: 40 radical prostatectomies from hormonally untreated patients with their preoperative biopsies, 10 radical prostatectomies from patients under complete androgen ablation before surgery and 10 simple prostatectomies from patients with bladder outlet obstruction. Results were compared with α-methylacyl-CoA racemase (AMACR). IGFBP2 was expressed in the cytoplasm of untreated adenocarcinomas and, to a lesser extent, in HG-PIN; the expression was markedly lower in patients after complete androgen ablation. AMACR was similarly expressed in both adenocarcinoma and HG-PIN, the level being similar in both lesions; the expression was slightly lower in patients after complete androgen ablation. IGFBP2 may be used a diagnostic marker of prostatic adenocarcinomas. 2) Heparan surface proteoglycan immunohistochemical expression was examined in 150 oral squamous cell carcinomas. Follow up information was available in 93 patients (range: 6-34 months, mean: 19±7). After surgery, chemotherapy was performed in 8 patients and radiotherapy in 61 patients. Multivariate and univariate overall survival analyses showed that high expression of syndecan-1 (SYN-1) was associated with a poor prognosis. In patients treated with radiotherapy, such association was higher. SYN-1 is a prognostic marker in oral squamous cell carcinomas; it may also represent a predictive factor for responsiveness to radiotherapy. 3) EGFR was studied in 33 pulmonary adenocarcinomas with traditional DNA sequencing methods and with two mutation-specific antibodies. Overall, the two antibodies had 61.1% sensitivity and 100% specificity in detecting EGFR mutations. EGFR mutation-specific antibodies may represent a predictive marker to identify patients candidate to tyrosine kinase inhibitors therapy.

Spinal cord injury: assessment of autonomic state-dependent control of cardiovascular system and body core temperature

Spinal cord injury (SCI) results not only in paralysis; but it is also associated with a range of autonomic dysregulation that can interfere with cardiovascular, bladder, bowel, temperature, and sexual function. The entity of the autonomic dysfunction is related to the level and severity of injury to descending autonomic (sympathetic) pathways. For many years there was limited awareness of these issues and the attention given to them by the scientific and medical community was scarce. Yet, even if a new system to document the impact of SCI on autonomic function has recently been proposed, the current standard of assessment of SCI (American Spinal Injury Association (ASIA) examination) evaluates motor and sensory pathways, but not severity of injury to autonomic pathways. Beside the severe impact on quality of life, autonomic dysfunction in persons with SCI is associated with increased risk of cardiovascular disease and mortality. Therefore, obtaining information regarding autonomic function in persons with SCI is pivotal and clinical examinations and laboratory evaluations to detect the presence of autonomic dysfunction and quantitate its severity are mandatory. Furthermore, previous studies demonstrated that there is an intimate relationship between the autonomic nervous system and sleep from anatomical, physiological, and neurochemical points of view. Although, even if previous epidemiological studies demonstrated that sleep problems are common in spinal cord injury (SCI), so far only limited polysomnographic (PSG) data are available. Finally, until now, circadian and state dependent autonomic regulation of blood pressure (BP), heart rate (HR) and body core temperature (BcT) were never assessed in SCI patients. Aim of the current study was to establish the association between the autonomic control of the cardiovascular function and thermoregulation, sleep parameters and increased cardiovascular risk in SCI patients.

Strukturelle, enzymkinetische und thermodynamische Untersuchungen am KLH, dem Hämocyanin der Schlüssellochschnecke Megathura crenulata

Hämocyanine sind große, kupferhaltige Sauerstoff-Transportproteine, die bei zahlreichen Schnecken extrazellulär in der Hämolymphe vorkommen. Das Keyhole Limpet-Hämocyanin (KLH) der Schlüssellochschnecke Megathura crenulata dient aufgrund seiner immunstimu-latorischen Eigenschaften seit vielen Jahren als Modellprotein in der Immunologie. In der Klinik wird es als Hapten- und Vakzincarrier sowie als Medikament gegen oberflächliche Harnblasenkarnzinome eingesetzt. Die Quartärstruktur des KLH besteht aus einem Hohl-zylinder mit einer Molekülmasse von 8 MDa und einem Durchmesser von 35 nm. Dieses sogenannte Didekamer setzt sich aus 20 Untereinheiten mit jeweils 400 kDa zusammen. Jede Untereinheit lässt sich weiter in acht funktionelle Einheiten a bis h (engl. Functional Units = FU) mit ~ 50 kDa unterteilen. Die FUs a bis f bilden die Wandregion des Moleküls, während der Kragen aus den FUs g und h geformt wird. Die Struktur der Wandregion sowie der FU-g konnte bisher bereits durch Röntgenstrukturanalysen aufgeklärt werden. Bezüglich der Struktur der FU-h, die sich durch eine spezielle C-terminale Verlängerung von ~ 100 Amino-säuren auszeichnet, sind allerdings noch keine Informationen verfügbar. Um die Architektur des Kragens zu verstehen, wurden im Rahmen dieser Arbeit zunächst Strategien entwickelt, diese spezielle FU in großer Menge und Reinheit zu isolieren. Anschließend konnten Bedingungen gefunden werden, die zur Ausbildung 0,2 mm großer, hexagonaler Kristalle führten. Diese ergaben am Synchrotron eine Auflösung von 4 Å. Durch Auswertung der Röntgenstrukturdaten konnte für die C-terminale Zusatzdomäne der FU-h eine Cupredoxin-ähnliche Typ I-Kupferfaltung ermittelt werden. Der Nachweis eines zusätzlichen Kupfer-atoms innerhalb dieser Domäne bedarf allerdings einer höheren Auflösung der Kristall-struktur. Hämocyanine lassen sich aufgrund ihrer evolutionären Verwandtschaft zu Phenol-oxidasen mit Hilfe verschiedener in vitro-Aktivatoren zur Catecholoxidase und teilweise auch zur Tyrosinase aktivieren. Beim KLH konnte in dieser Arbeit eine eindeutige Diphenolase- und sogar eine schwache Monophenolase-Aktivität der FUs-a und -f nach SDS-Aktivierung nachgewiesen werden. Zudem konnte eine geringfügige intrinsische Diphenolase-Aktivität dieser FUs belegt werden. Die enzymatischen Reaktionen waren sowohl von der gewählten Puffersubstanz, als auch der Anwesenheit bivalenter Kationen abhängig. Tris wirkt vermutlich als allosterischer Effektor und steigerte den Substrat-Umsatz, während Mg2+-Ionen zu einer starken Inhibition der katalytischen Aktivität führten. Die Klärung einer möglichen physiologischen Funktion der Phenoloxidase-Aktivität des KLH sowie potenziellen in vivo-Aktivatoren steht noch aus. Studien zur thermischen Stabilität des KLH resultierten in einer irreversiblen Denaturierung des Proteins. Die Schmelzpunkte deuteten auf eine hohe Tempe-raturstabilität des KLH, vor allem in Anwesenheit bivalenter Kationen. Eine Hämocyanin-typische Abhängigkeit der Hitzeresistenz vom Oligomerisierungsgrad ließ sich nicht feststellen, da sowohl bei der FU-h als auch den KLH-Didekameren eine vergleichbar hohe thermische Stabilität, bei einer nach wie vor vorhandenen Oxygenierung beobachtet wurde.

Zur Geschichte des "Anilinblasenkrebses" bei Farbenarbeitern am Beispiel der Farbwerke Hoechst

Durch die Entwicklung der chemischen Industrie im 19. Jahrhundert traten völlig neue medizinische Probleme auf. 1895 postulierte Dr. Ludwig Rehn, ein Chirurg am Städtischen Krankenhaus in Frankfurt am Main, auf dem Chirurgenkongreß erstmals einen Zusammenhang zwischen dem Blasenkarzinom und seinem gehäuften Auftreten bei Arbeitern der organisch-chemischen Farbenfabriken. Er hatte bemerkt, daß er in relativ kurzer Zeit einige Patienten mit Blasenkrebs operiert hatte, die auffälligerweise alle in derselben Fabrik arbeiteten. Da diese Krankheit sehr selten war, versuchte er in Zusammenarbeit mit Heinrich Paul Schwerin das Phänomen zu ergründen. Einerseits mußte die schädliche Substanz selbst genau identifiziert werden, andererseits die Kanzerogenese aufgeklärt sowie eine Therapie gefunden bzw. prophylaktische Maßnahmen eingeleitet werden. Wie auch heute bei vielen neuen Entdeckungen dauerte es Jahrzehnte, bis Ärzte diese These anerkannten. Besonders starke Anfeindung erfuhr Ludwig Rehn von Fabrikärzten aufgrund ihrer Verpflichtung für das Wohlergehen der Arbeiter und ihrer Abhängigkeit von der wirtschaftlichen Prosperität der Fabriken, z. B. von Friedrich Wilhelm Grandhomme. Es ergab sich die bis heute bestehende Schwierigkeit, zwischen den Wünschen der produzierenden, arbeitsplätzeschaffenden Industrie und dem Schutz der Arbeitnehmer und der Umwelt einen Konsens herzustellen. Die Probleme Therapie und Prophylaxe sowie Identifikation aller Blasenkrebs verursachenden Substanzen sind auch im 21. Jahrhundert noch nicht völlig geklärt.

Protonterapia nel trattamento del tumore prostatico

Obiettivo: Il nostro obiettivo è stato quello di confrontare la tomoterapia (HT) e la protonterapia ad intensità modulata (IMPT) nel trattamento del tumore prostatico, seguendo un protocollo di boost simultaneo (SIB) e moderatamente ipofrazionato. Materiali e metodi: Abbiamo selezionato 8 pazienti, trattati con HT e abbiamo rielaborato i piani con 2 campi IMPT. La dose prescritta è stata di 74 Gy sul PTV1 (prostata e vescicole seminali prossimali), 65.8 Gy sul PTV2 (vescicole seminali distali) e 54 Gy sul PTV3 (linfonodi pelvici). Risultati: Sia con IMPT che con HT abbiamo ottenuto una copertura e una omogeneità di dose del target sovrapponibile. Oltre i 65 Gy, HT e IMPT erano equivalenti per il retto, mentre con l’IMPT c’era maggior risparmio della vescica e del bulbo penieno da 0 a 70 Gy. Da 0 fino a 60 Gy, i valori dosimetrici dell’IMPT erano molto più bassi per tutti gli organi a rischio (OARs), eccetto che per le teste femorali, dove la HT aveva un vantaggio dosimetrico rispetto all’IMPT nel range di dose 25-35 Gy. La dose media agli OARs era ridotta del 30-50% con l’IMPT. Conclusioni: Con le due tecniche di trattamento (HT e IMPT) si ottiene una simile distribuzione di dose nel target. Un chiaro vantaggio dosimetrico dell’IMPT sul HT è ottenuto dalle medie e basse dosi. Le attuali conoscenze sulle relazioni dose-effetto e sul risparmio delle madie e basse dosi con l’IMPT non sono ancora state quantificate dal punto di vista clinico.

La navigazione nella chirurgia oncologica ortopedica: Applicazione ed implementazione di nuove tecnologie per il trattamento chirurgico dei tumori dell'apparato muscolo-scheletrico, studio pilota

Nel presente progetto di ricerca, da novembre 2011 a novembre 2013 , sono stati trattati chirurgicamente, con l’assistenza del navigatore , pazienti con tumori ossei primitivi degli arti, del bacino e del sacro, analizzando i risultati degli esami istologici dei margini di resezione del tumore e i risultati clinici e radiografici. Materiali e metodi : Abbiamo analizzato 16 pazienti 9 maschi e 7 femmine , con un'età media di 31 anni (range 12-55 ). Di tutti i pazienti valutati 8 avevano una localizzazione agli arti inferiori , 4 al bacino e 4 all'osso sacro . Solo quelli con osteosarcoma parostale , Cordoma e Condrosarcoma non sono stati sottoposti a terapia antiblastica . Solo un paziente è stato sottoposto a radioterapia postoperatoria per una recidiva locale . Tutti gli altri pazienti non sono stati trattati con la radioterapia per l’ adeguatezza dei margini di resezione . Non ci sono state complicanze intraoperatorie . Nel periodo postoperatorio abbiamo osservato una vescica neurologica , una paresi sciatica, due casi di infezione di cui una superficiale e una profonda, tutti e quattro i pazienti con sarcoma sacrale sviluppati hanno avuto ritardato della guarigione della ferita e di questi tre hanno avuto incontinenza sfinterica. In tutti i casi si è ottenuta una eccellente risultato clinico e radiografico , con soddisfazione del paziente , corretto contatto tra l'osteotomia e l'impianto che apparivano stabili ai primi controlli ambulatoriali ( FU 19 mesi). Risultati: La chirurgia assistita da calcolatore ha permesso di migliorare l’esecuzione delle resezioni ossee prevista dal navigatore. Questa tecnologia è valida e utile per la cure dei tumori dell’apparato scheletrico, soprattutto nelle sedi anatomiche più complesse da trattare come la pelvi, il sacro e nelle resezioni intercalari difficoltose nell’ottenere un margine di resezione ampio e quindi di salvare l’articolazione e l’arto stesso.