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Biomedical subjects

D Springfield

Publications and source records attributed to D Springfield.

15 recordsLinked to original sources
PubMed1996

Autograft reconstructions.

Autogenous bone and cartilage grafts provide the optimal material to be used in reconstruction of the skeleton. If there were an adequate supply of autogenous bone grafts of ideal size and shape, there would be no need for allograft or endoprosthetic replacements. Unfortunately, the major limitation to the use of autografts is their short supply. This is especially true when articular cartilage is needed. The other shortcoming of autogenouus grafts is the donor site morbidity, which, although modest, is of concern to the patient and, on rare occasions can lead to a significant complication. In the future, we may be able to have patients make their own autogenous bone and cartilage grafts, but for now we are limited to small corticocancellous grafts, strips of tibia or iliac crest, a rib, or the fibula. Clinically useful cartilage grafts can be obtained only from the proximal fibula or patella.

Bone Neoplasms↗
PubMed1995

Combined surgery and radiation therapy for limb preservation in soft tissue sarcoma of the extremity: the Massachusetts General Hospital experience.

The results presented here indicate that excellent local control rates can be achieved using radiation in combination with limb-sparing surgery. At least three challenges remain and need to be addressed in future prospective trials. One is the need to reduce wound complications. In this regard, the influence of chemotherapy on the healing of the irradiated wound needs to be better defined as well as the role of recombinant growth factors and cytokines in tissue repair. Second is the need to better assess functional and psychological outcome in patients who are long-term survivors as well as in patients who succumb to distant disease. Despite the limited information on this end-point, it appears that strategies that reduce wound morbidity ultimately have a beneficial outcome with regard to functional and psychological status. Third, our greatest challenge is to improve the rates of distant disease control. Despite excellent local control rates following limb-sparing procedures, greater than 50% of patients will ultimately die of their disease. New systemic therapies must be developed to control systemic dissemination. The ultimate goal of combined surgery, radiation, and chemotherapy will be to preserve limb function in patients who are cured of their disease.

Brachytherapy↗
PubMed1993

Extensive skeletal metastases from chondrosarcoma without pulmonary involvement.

Among 251 patients who presented to our orthopedic oncology unit over the last 20 years with chondrosarcoma, we identified two patients with low to intermediate grade conventional chondrosarcoma who developed multifocal bone metastases in the absence of pulmonary spread. The metastatic lesions were of a similar histologic grade to the primary site. One of the patients had synchronous foci, while the other developed the bone lesions 3 years after initial presentation. The unusual behavior of these cases, as well as the possibility that they may represent instances of multicentric chondrosarcoma, is discussed.

Adult↗
PubMed1993

Liposarcoma.

Liposarcoma is second in frequency only to malignant fibrous histiocytoma among the soft-tissue sarcomas. It occurs almost exclusively in adults and is found most often in the thigh or retroperitoneum. It rarely arises from a lipoma and does not occur in the subcutaneous tissues. Liposarcomas are divided into histologic subtypes with different microscopic appearances and slightly different behavior characteristics. Surgical resection with a wide surgical margin is the treatment of choice. When amputation is required to obtain an adequate surgical margin, local irradiation can be used as an adjuvant and a limb-sparing operation can be done. Currently, no evidence exists that adjuvant chemotherapy is indicated for patients with liposarcoma, although numerous studies are being done to investigate its use. As is the case for all sarcomas, the lung is the most common site of metastasis; however, liposarcoma has an unusual propensity to metastasize to the retroperitoneum, mediastinum, and bone.

Adult↗
PubMed1992

Ablation of osteoid osteomas with a percutaneously placed electrode: a new procedure.

Osteoid osteoma is a benign, self-limited tumor of bone that usually requires surgical excision for relief of pain and to prevent long-term consequences. Radio-frequency electrodes have been successfully and safely used to ablate small areas of the central nervous system and to perform ablation elsewhere in the body. The authors have used this technique in four patients with proved or presumptive osteoid osteoma, completely relieving the symptoms in three.

Adult↗
PubMed1987

Neoadjuvant chemotherapy for osteosarcoma of the extremity.

Eighty-five patients with nonmetastatic, high-grade osteosarcoma of an extremity received intravenous methotrexate and intraarterial cisplatinum and then a definitive surgical resection. The preliminary results suggest that preoperative chemotherapy with a delayed surgical resection is as safe as immediate surgery. More patients are candidates for limb salvage after chemotherapy. The tumor response to the preoperative chemotherapy also has prognostic value. Reducing the postoperative chemotherapy can be dangerous. A high dose methotrexate may not be necessary.

Adolescent↗
PubMed1986

Giant cell tumor of bone with pulmonary and lymph node metastases. A case report.

A giant cell tumor of bone appeared in a lymph node of a 21-year-old man at the time of local recurrence in its original location in the distal femur, prior to metastasizing the lung. Following a wide resection, the lesion did not recur, but asymptomatic pulmonary metastases were discovered. DNA analysis by flow cytometry demonstrated identical patterns in the primary and initial recurring lesions, as well as in the pulmonary metastases, which suggests that this technique may be a valuable diagnostic tool for assessing the potential aggressiveness of giant cell tumor of bone. Giant cell tumor of bone is rarely associated with metastases of any kind. Rare instances of pulmonary spread have been reported in the literature. Lymph node involvement is even more unusual. Only two such cases have been previously reported.

Adult↗
PubMed1985

Adjuvant chemotherapy for malignant fibrous histiocytoma in the femur and tibia.

Between 1974 and 1982, twelve patients with malignant fibrous histiocytoma of the femur and tibia were treated by excision and adjuvant chemotherapy. During the same time-period, eighteen patients were treated by excision alone. The disease-free survival rate among the former was 59 per cent (seven of twelve). There was only one survival in the latter group.

Adolescent↗
PubMed1985

The surgical treatment of parosteal osteosarcoma in long bones.

The cases of twenty-five patients with Stage-I parosteal osteosarcoma were analyzed to ascertain the incidence of recurrence after forty-two various surgical procedures that produced an intracapsular, marginal, wide, or radical excisional margin. Ten intracapsular resections were followed by local recurrence in each patient. This procedure usually was done to shell-out a presumably benign lesion. Marginal excision was successful in nine of seventeen patients. When a marginal excision was knowingly done to preserve a major neurovascular bundle, the risk of recurrence was less (three of eleven) than when it was done to shell-out a presumptively benign lesion (five of six). The fourteen procedures that achieved wide margins obtained local control--that is, there was no recurrence--in each patient. There was one radical procedure without recurrence.

Adolescent↗
PubMed1983

Arterial prostacyclin generation is decreased in patients with malignant bone tumors.

Arterial production of PGI2 was measured in patients with malignant bone tumors and compared to that in arteries from subjects with benign bone tumors and others without tumor. Arteries from all study subjects exhibited spontaneous and arachidonate-induced PGI2 release. Arterial production of PGI2 as measured by 6-keto-PGF1 alpha was in the normal range in patients with benign tumors. In contrast, arteries from patients with malignant tumors had lower PGI2 release. Deficient arterial PGI2 production in patients with malignant tumor was present both at rest and upon stimulation of blood vessels with arachidonate. Decreased PGI2 generation could relate to tumor attachment to the endothelium, penetration of the vessel walls and subsequent metastasis.

Bone Neoplasms↗
PubMedDate not supplied

Magnetic resonance imaging of sacrococcygeal tumors.

Five sacral tumors, 2 chordomas, 2 chondro- and/or osteosarcomas and one metastasis were examined with magnetic resonance imaging (MRI). The tumor delineation was excellent in all cases, and in several respects superior to CT. The signal pattern from the chordoma differed considerably from the other tumors suggesting a potential for tumor differentiation with MRI.

Adolescent↗
PubMedDate not supplied

Magnetic resonance imaging and tissue characterization of a renal cell carcinoma and its osseous metastasis. Report of a case.

A patient with renal cell carcinoma, first presenting because of symptoms from an osseous metastasis, was examined with CT and magnetic resonance imaging (MRI). Both the primary tumor and the metastasis were well demonstrated by both methods. MRI tissue characterization showed that the T1 values in the kidney and the metastasis were the same, as were the T2 values. This may mean a potential for the MRI to define primary tumors when a metastasis is found.

Aged↗