The Iowa orthopaedic journal
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Giant cell tumor is an aggressive benign neoplasm of bone. A number of adjuvant agents have been used to supplement intralesional curettage to reduce the otherwise high local recurrence rate. High concentration ethanol is more readily available and less toxic to use than some common alternatives. ⋯ Multiple washes with high concentration ethanol, when used in conjunction with aggressive curettage including high-speed burring, is an effective and safe adjuvant. The necessity of any chemical adjuvant after appropriately aggressive curettage and burring can only be definitively demonstrated with a prospective, randomized, multi-center trial. Until such evidence becomes available, the use of adjuvant ethanol offers a compromise between higher toxicity adjuvants and no chemical adjuvant at all.
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Outpatient pain rehabilitation programs that include an interdisciplinary approach have been shown to be effective treatments for patients with chronic pain. The objectives of this article are to describe the common interdisciplinary pain rehabilitation programs available, the appropriate indications for use, the components of typical pain rehabilitation programs, the short-term and long-term success rates, the costs of attending these programs, and the significant societal costs of those patients who do not complete these programs and do not return to work.