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Biomedical subjects

B M Persson

Publications and source records attributed to B M Persson.

At least 55 records · Page 3Linked to original sources
PubMed1984

Epidemiology of soft-tissue sarcoma in the locomotor system. A retrospective population-based study of the inter-relationships between clinical and morphologic variables.

From all soft-tissue malignancies reported to the Swedish National Cancer Registry in Southern Sweden (1.3 mill. inhabitants) from 1964 through 1978, 278 cases were accepted as sarcomas after histologic re-examination. All these were malignancy-graded on a four-grade scale, without knowledge of the clinical course. A number of clinical and morphological variables were recorded and subjected to uni-, bi- and multi-variate analysis. Follow-up was available in all patients. The annual incidence rate over all ages was 1.4/100,000. The mean age was 58 years and males dominated (1.3/1). Malignant fibrous histiocytoma, liposarcoma and leiomyosarcoma were the most common histologic groups. Three-fourths of the tumors were high-grade malignant (Grade III-IV). Sixty per cent were deep-seated, having a median size of 8 cm compared to 4 cm for the superficial tumors. One third of all tumors were located in the thigh. The histologic groups were characterized by age, tumor depth and size, the occurrence of pain, malignancy grade and five-year survival; it was seen that each group, with respect to at least one of the variables, differed significantly from all the other groups. Thus histologic classification seems to identify different tumor entities. Out of several pair-wise associations the strongest were as follows: histologic groups versus depth, size, malignancy grade and age; depth versus size; and size versus malignancy grade (Grade IV tumors being larger). The proportion of superficial and small tumors in this series is high, compared to several reported series, probably owing to "referral selection" in the previous studies. The inter-relationships found between several variables and conclusions based on selected series may explain, in part, the differing opinions which can be found in the literature regarding prognostic variables in soft-tissue sarcoma.

Adolescent↗
PubMed1984

Prognosis for soft-tissue sarcoma in the locomotor system. A retrospective population-based follow-up study of 237 patients.

To identify variables of prognostic importance for soft-tissue sarcoma in the locomotor system, we performed a retrospective follow-up study on a consecutive, unselected, population-based series of 237 patients mainly treated by surgery, 1964-1978. Patients with metastasis at the time of diagnosis were not included. All histologic material was re-evaluated and histologic malignancy-grading (four-grade scale) performed without knowledge of the clinical course. The surgical procedures were classified as marginal and broad excisions. Patient follow-up ranged between 3- and 18 years. Multivariate analysis of the data by Coxs proportional hazard regression techniques disclosed seven negative prognostic variables of primary significance; high malignancy-grade (IV and III), pain at rest, male sex, increasing age and tumor size, a marginal excision and an extracompartmental tumor site, in order of decreasing relative risk (5.9-1.9) as regards survival. A secondary variable, that of local recurrence, was then included in the model and was found to have a stronger influence on survival than any of the other variables. Patients with local recurrence had a mortality risk which was 8.3 times that of patients without local recurrence. A risk curve based on the prognostic variables having primary significance was constructed. By this risk curve, patients with very good or very bad prognosis could be identified. The results are important when evaluating the efficiency of different therapies in non-randomized trials. In such studies the prognostic variables could be used to identify patients having comparable prognoses. In addition, patients found to have a good prognosis could be excluded from trials with adjuvant therapy.

Adolescent↗
PubMed1983

A clinical standard of stump measurement and classification in lower limb amputees.

The dimensions and healing of 93 consecutive below-knee stumps were studied and based on observations a standard formula of stump classification was constructed (and discussed at the ISPO Meeting in Bologna 1980). Muscular atrophy and redistribution of oedema caused a mean reduction of calculated arbitrary stump volume of about 7% during the first 12 post-operative weeks accompanied by a change in distal circumferential measurement ranging between 7 centimetres reduction and 5 centimetres increase. The classification formula was tested in 135 examinations in 86 patients with 96 stumps in Lund. A new proportional definition of stump length was used. Eighty per cent were ordinary in length and shape. Ten of 59 were conical before one year compared to 12 of 42 after more than one year following amputation. Pain was a problem in 20%. Scar problems are common early but other skin damage increases with time. Skin problems are separated according to cause, i.e. pressure, suction, infection and allergy. One third of below-knee stumps had unhealed wound or damaged skin. Surgical correction was indicated in 2% and prosthetic correction in 7%. Prosthetic correction seemed to be more often needed in below-knee stumps and surgical correction in above-knee stumps.

Adolescent↗
PubMed1983

Tolerance of early walking with total contact among below-knee amputees--a randomized test.

In order to reduce the need for repeated changes of socket due to postoperative atrophy and resorption of oedema simple temporary limbs are required to delay the casting of individual sockets until the stump is more mature. A randomized study of 95 below-knee amputees was performed with a re-usable temporary one-size prosthesis of endoskeletal type with adjustable tube length. Total contact was obtained by moulding a thin plastic pillow containing small plastic pellets around the stump in parallel connected sections. As air was evacuated the pillow became rigid. The pillow was kept in place about the stump by Velcro bands. Physiotherapists were able to make all adjustments and ambulate the patient 1-2 hours a day. The training started 2-4 weeks after amputation and lasted for 1-4 weeks. Healing problems due to training did not occur in well healed stumps where training started 3 weeks or more after amputation. No negative influence on maturing of stump, hospital stay and walking ability three months after amputation was found.

Aged↗
PubMed1983

Increased incidence of lower limb amputation for arterial occlusive disease.

The number of amputations in Malmöhus county with just over 500 000 inhabitants had increased from 14 to 161 during the years 1910-79 measured each fifth year comprising totally 724 observations. The number of amputations compared to the age related incidence 1979 had increased four times. Age, diabetes mellitus and sex proportions of ischemic amputees were studied and compared to other Scandinavian reports over the last 30 years. The proportion of diabetic amputees (0.37) and the male proportion (0.54) seemed unchanged, but the proportion of amputees at least 80 years old had increased from about 0.09 to 0.38.

Adult↗
PubMed1983

Treatment of soft-tissue sarcoma should be centralised.

New concepts regarding surgical margins and new modalities of preoperative examination make centralized care advantageous for patients with soft-tissue sarcomas. This study describes how the organizational level of surgical service and surgical technique have changed with time in southern Sweden. After reviewing all cases of soft-tissue sarcoma in the trunk and extremities registered during 1964-81, 261 patients remained for analysis. The material was divided into patients treated within or outside the Orthopaedic Oncology Group (OOG) for southern Sweden, which started in 1970. Patients treated by the OOG were separated into patients referred before and after surgery. In 1964-69, one-third (25/73) of the patients had a wide or compartmental excision at final surgery of the primary tumour compared with two-thirds (126/188) in 1970/81. Further, four-fifths (111/142) of the patients treated by the OOG finally had wide or compartmental excisions, whereas only one-third (15/46) of the patients treated outside the OOG over the same time period had obtained this type of surgery. When recorded, the tentative pre-operative diagnosis was a benign lesion in more than one-half of the patients treated outside the OOG. In two-thirds of the patients referred before surgery the biopsy and treatment, a wide or compartmental excision, were combined into one surgical procedure. Over the years the number of patients referred increased. During 1980-81, 35 of 38 patients with soft-tissue sarcomas were referred to the OOG: 11 before any biopsy, 14 after a malignant cytodiagnosis and 10 following marginal excisions.

Adolescent↗
PubMed1983

Age, diabetes and smoking in lower limb amputation for arterial occlusive disease.

The increased number of amputations for arterial occlusive disease noted in western countries is only partly explained by increasing numbers of the elderly. A prospective analysis of the influence of diabetes and smoking habits was therefore carried out. In 1978-81, 188 lower limb amputees in Lund were examined and classified as non-smokers, ex-smokers, light smokers and heavy smokers. These figures were compared with corresponding figures among age-correlated controls and to a group of hip fracture patients. The material was divided into men and women and into non-diabetics and diabetics. Smokers had much lower mean age at amputation. Out of 188 amputees only 23 were not either a diabetic, a smoker or 80 years or more. The population study indicates a correlation between smoking and amputation for ichaemia. The coincident increase in cigarette consumption in Sweden is illustrated and it is suggested that smoking should be noted as routinely as diabetes at amputations.

Adult↗
PubMed1983

Internal fixation of supracondylar and bicondylar femoral fractures using a new semielastic device.

Previous reports of failures following surgery of distal femoral fractures prompted the development of a semielastic internal fixation device suitable for the mechanically weak bone of the elderly. The fixation device consists of intramedullary elastic Ender-type nails connected to cancellous screws at each condyle by a special coupling piece. Thus, the intercondylar fracture is rigidly stabilized by screws and adjusted to the supracondylar fracture by connected elastic nails. The device is easily applied through small incisions. During a two-year period 54 fractures of the distal third of the femur were treated. Most patients were elderly and suffered from concurrent diseases or previous ipsilateral fractures. The goal was twofold: to avoid traction in bed and to start early mobilization. Fifteen undisplaced fractures were treated by plaster or cast-brace. Five fractures were treated by traction. Thirty-four displaced supracondylar and bicondylar fractures were operated on using the new fixation device. No deep infections or osteomyelitis occurred. Immediate mobilization was possible in all 34 cases, most with an external support of plaster for two weeks and a hinged cast-brace for eight weeks. Twenty-nine patients were followed up to union; results in these displaced supracondylar and bicondylar femoral fractures were excellent in 12, good in nine, fair in five, and poor in three patients. The semielastic character of the system seemed to prevent the failures observed with the use of rigid internal fixation in osteoporotic bone.

Adolescent↗
PubMed1982

Measurement of maximal end-weight-bearing in lower limb amputees.

Modern sockets for lower limb amputees utilize total contact and distribute some weight on the stump end. Its tolerance to bear weight varies but is better after joint disarticulation, however, systematic measures have been missing. Different levels, indications, shapes etc. were analysed with 102 measurements in 69 patients. The maximal-end-weight-bearing of the stump measured on a scale was much lower after transmedullar amputations than after disarticulations. Men had a mean tolerance more than 15 kg but women less than 10 kg. There was a positive correlation to body weight. Diabetics tolerated significantly more end-bearing and patients with phantom pain more than patients with stump pain. Within each category of stumps the range of maximal end-weight-bearing was large. Among all below-knee amputees the tolerance was between 2 to 55 kg or 3 to 79 per cent of body weight. Pointed stumps statistically tolerated about as much as rounded ones and the variability of contact surface was not measured as its sensitivity to pain must be unevenly distributed. It is concluded that this simplified method is helpful to analyse pain and to modify end-weight-bearing more individually.

Aged↗
PubMed1982

Aspiration cytology of soft tissue tumours. A prospective study of its influence on choice of surgical procedure.

Tumour cells may be dispersed into the wound when diagnostic or excisional biopsy is undertaken. This risk is reduced by using fine needle aspiration biopsy. The definitive excision of a soft tissue sarcoma may then be carried out in a more limited manner. In selected cases diagnostic and definitive operation may be combined, accepting the risk of excision of a benign lesion with unnecessarily broad margins. Aspiration cytology could possibly help the surgeon to decide on the extent of the excision. One hundred and nine consecutive patients with soft tissue lesions were referred to the Orthopaedic Oncology Group at Lund in Southern Sweden because of suspected malignancy. Biopsy had not been carried out. Further diagnostic and therapeutic procedures were planned as if aspiration cytology was not going to be used. The procedure was then performed with a fine needle and the cytodiagnosis was used to modify the plan. Sixty-seven tumours were examined histologically. Ten were sarcomas, two metastatic carcinomas and one a malignant lymphoma. The surgical plan was changed after the cytology was known in 33 of the 109 cases. Compartmental or wide excisions which had been planned became unnecessary in 20 patients. No operation was done in 6 patients and in 14 others a more limited excision was carried out. It was possible to avoid planned incisional biopsy in 3 patients with sarcoma.

Adolescent↗
PubMed1980

Supracondylar femoral fractures as a complication to Ender nailing of trochanteric fractures. A new device for osteosynthesis.

Supracondylar femoral fractures is an uncommon complication to Ender nailing of a trochanteric fracture. Seven cases were traced to study the fracture pattern and the results of the therapy. The most common fracture type extends obliquely from the hole of the insertion medially in a proximo-lateral direction. Prolonged traction in bed in these cases should be avoided. Rigid internal fixation using angle blade plates if frequently insufficient in highly osteoporotic bone. As an alternative to both traction in bed and rigid fixation a new osteosynthetic device for semielastic fixation was used as demonstrated in two of these cases. It has a connection piece between one elastic intramedullary nail of the Ender type and two cancellous bone screws. The device, applied from the medial as well as the lateral condyle, ensures a fixation less prone to mechanical failure in osteoporotic skeleton. It does not interfere with the loading forces of the bone and is stable enough to allow patients to be mobilized from bed. We now use it for all types of distal femoral fractures.

Aged↗
PubMed1979

Excisional biopsy for bone tumours.

Compartmental muscular resections without open biopsy is a common procedure for soft tissue tumours suspected of malignancy. In bone tumours, where the diagnosis is supposed to be sarcoma, an excisional biopsy is seldom possible without severe recontructive problems and it may be unnecessarily mutilating should the tumour be benign. For the fibula, the clavicula, metatarsal and metacarpal bones, the distal third of ulna and the proximal third of radius, however, excisional biopsy as the primary procedure should be taken into account. The resulting loss of function is minor and can well be accepted even if the tumour turns out to be benign. On the other hand, if it is malignant as supposed, the radical excisional biopsy saves the patient from amputation. When incisional biopsy is used instead of excisional biopsy the definite surgery has to be made much wider and will often be mutilating. A case of chondrosarcoma illustrates the advantage and the disadvantage of this principle as well as an unusual reconstruction.

Adult↗
PubMed1978

Bilateral femoral shortening for overgrowth in young adults.

Through 17 years ten patients were treated for psychologically unacceptable tallness by bilateral femoral shortening. All were young adults between 17 and 28 years; one was acromegalic, one had Marfans syndrome and the other were tall for unknown reasons. The amount of shortening obtained was between 6 and 16 cm. One patient was reoperated bilaterally because of insufficient stability of the pin and plate fixation. All patients healed without significant complications. For exclusive cases, which have been carefully observed over several months, bilateral shortening seems to be a safe procedure either with midshaft shortening and Küntscher nailing or subtrochanteric femoral shortening with pin and plate fixation. At review all patients were satisfied with their decision to be surgically shortened. Similar cases seem not to have been published.

Adolescent↗
PubMed1978

Results of surgical treatment for non-union after high tibial osteotomy in osteoarthritis of the knee.

In a series of 280 high tibial osteotomies performed for osteoarthritis of the knee between 1969 and 1975, there were ten cases of pseudarthrosis, an incidence of 3.6 per cent. These ten knees (and an additional two that were referred to us) were reoperated on. In most cases the pseudarthrosis was resected and stabilized with the Charnley transfixation-compression method. Other procedures involved resection without compression (one knee), compression blade-plate fixation, and arthroplasty with a hinge endoprosthesis. All osteotomies healed eventually with the knee in satisfactory position. In spite of the initial non-union and repeated operation, all twelve patients eventually had satisfactory correction of the preosteotomy deformity, and none had a loss in walking ability. All but two patients had freedom from pain. We concluded that patients with non-union following high tibial osteotomy for osteoarthritis of the knee should undergo resection of the pseudarthrosis and transfixation compression as the treatment of choice. Endoprosthetic replacement then can be used as a salvage procedure if it is needed.

Aged↗
PubMed1978

Technical aspects of midshaft femoral shortening with Küntscher nailing.

Surgical shortening of the lower limb in adults with unequal leg length is a rare procedure making up about 0.05% of all orthopedic operations. Most often a subtrochanteric level and nail-plate fixation is used. Early weight-bearing with this technique can, however, result in metallic failure. As is illustrated in 11 cases, midshaft femoral shortening operations with intramedullary nailing are hazardous because of rotational or longitudinal instability. As a precautionary measure, extra reaming and locking osteotomy can be performed. This makes intramedullary nailing a relatively safe procedure, and allows immediate full weight-bearing.

Adolescent↗
PubMed1977

Radiotherapy and surgery in 50 cases of osteosarcoma treated without adjuvant chemotherapy.

A consecutive series of osteosarcoma patients from one hospital is described. In 1962 radiotherapy with delayed surgery according to Cade was replacing surgery alone as the adopted treatment programme. Statistically the results were the same before and after this time with 5 out of 29 and 6 out of 21 patients, respectively, surviving 5 years. With radiation alone none out of eight survived. Surgery alone produced 3 out of 14 and radiation with delayed surgery 6 survivors out of 15. As surgery with or without radiotherapy is equally ineffective in controlling osteosarcoma a prospective randomized trial of the relative merits of chemotherapy and interferon as adjuvant therapy seems highly desirable.

Adolescent↗
PubMed1976

Fine needle aspiration biopsy in the evaluation of tumor-like lesions of bone.

A consecutive series of bone lesions suspected to be tumors and examined by fine needle aspiration biopsy at the University Hospital Cytology Laboratory in Lund, Sweden, is reported. From 1966 to November 1974, 150 cases were examined. In 123, sufficient cellular material was obtained through aspiration by a needle with an outer diameter of 0.8 mm. The method is described. The reliability of cytology is compared with the results of the definite pathology after open biopsy or extirpation of the lesion. In the series of primary benign lesions 28 out of 39 were correctly diagnosed; among primary malignant 27 out of 38 were correct and among metastases 57 out of 73 were correctly diagnosed including those where insufficient cellular material was aspirated. In cases where sufficient material was achieved the reliability of the cytological diagnosis was around 90 per cent. There was one false positive and two false negative reports of malignancy. Fine needle aspiration biopsy with cytology is recommended as a standard step in orthopedic oncological examinations. It has at least the same degree of diagnostic reliability as other diagnostic methods, such as X-ray, for instance; however, it does not replace open biopsy and histology when mutilating surgery is in question.

Biopsy, Needle↗