Search PubMed⌕ Search

Biomedical subjects

E F McCarthy

Publications and source records attributed to E F McCarthy.

At least 37 records · Page 2Linked to original sources
PubMed2000

Soft-tissue masses: when and how to biopsy.

Patients with soft-tissue tumors present a diagnostic challenge to the clinician. A systematic approach to evaluation and biopsy is necessary to minimize diagnostic errors and biopsy complications. With MRI, the clinician and radiologist are able to precisely identify some soft-tissue masses, such as lipomas, ganglions, hemangiomas, and popliteal cysts. Most soft-tissue tumors have signal characteristics that are low signal on T1-weighted images and high signal on T2-weighted images. Soft-tissue masses that cannot be identified are called indeterminate masses, and a biopsy is necessary to identify these lesions. Needle biopsy and open incisional biopsy are effective methods to histologically identify the nature of the tumor. Open excisional biopsy should be performed only when the surgeon knows that the soft-tissue lesion is benign.

Biopsy↗
PubMed2000

The role of MR imaging in soft tissue tumor evaluation: perspective of the orthopedic oncologist and musculoskeletal pathologist.

Soft tissue masses are common in both children and adults. Clinicians must evaluate patients carefully to avoid management errors. The most effective management decisions are made when a working group composed of clinicians, radiologists, and pathologists participates in the interpretation of the imaging studies. Plain-film radiographs and MR imaging scans are the two main imaging modalities used in patients with soft tissue masses. The working group assimilates the clinical and radiographic data to determine if they can identify the nature of the soft tissue mass. When the group can assign a definitive diagnosis, the lesion is designated as a determinate lesion. Determinate lesions include lipomas, ganglions, hemangiomas, neurofibromas, diabetic myonecrosis, muscle tears, myositis ossificans (heterotopic ossification), and pigmented villonodular synovitis. When the process cannot be identified, the lesion is classified as indeterminate. All soft tissue sarcomas are indeterminate lesions. Many benign lesions are also indeterminate. Common examples include schwannomas, myxomas, and giant cell tumor of tendon sheath. Based on the clinical and radiologic features, these diagnoses may be suspected, but because of the inability to distinguish them from sarcomas based on the MR imaging features, they are usually classified as indeterminate. When lesions are judged to be determinate, observation or excisional biopsy are the two major treatment choices. When lesions cannot be identified on the imaging studies, incisional or needle biopsy is performed to establish a diagnosis. Once a diagnosis is made, the proper management choice can be selected. Inappropriate excisional biopsy is the major treatment error in the management of soft tissue tumors. When a high-grade soft tissue sarcoma is resected with multiple positive margins, the risk of local failure after definitive resection is much higher than if the patient had been treated initially with only a needle or incisional biopsy. Also, if a major complication, such as an infection, a major wound-healing problem, or contamination of the major neurovascular structures, occurs at the time of incisional biopsy, amputation of the limb may be necessary. Inappropriate excisional biopsy can occur when a surgeon is not familiar with the features of sarcomas or when a radiologist mistakenly interprets the signal features as a benign lesion.

Adult↗
PubMed1999

Pigmented villonodular synovitis of the hip and knee.

Pigmented villonodular synovitis is an uncommon disease that remains a diagnostic challenge. Presenting complaints commonly involve one joint, most often the knee or hip. Symptoms of pain and swelling characteristically have an insidious onset and are slowly progressive. The physical examination may be completely normal. Radiographs of the knee may appear normal or may show a periarticular soft tissue density, expansion of the suprapatellar pouch and local osseous changes confined to the patellofemoral articulation. Radiographs of the hip may show erosions in the head and neck of the femur and acetabulum. Magnetic resonance imaging usually demonstrates key diagnostic features, which include joint effusion, elevation of the joint capsule, hyperplastic synovium and low signal intensity resulting from hemosiderin deposition. The diagnosis of pigmented villonodular synovitis is confirmed by biopsy, and the treatment of choice is synovectomy.

Diagnosis, Differential↗
PubMed1999

Lytic Paget disease as a cause of orbital cholesterol granuloma.

A case of histologically confirmed Paget disease of the orbit produced a lesion that appeared both clinically and histologically similar to a cholesterol granuloma. This case is unique because of the unusual location of the lesion, its presentation in a patient with no other manifestations of Paget disease, and the histological picture produced by the disease.

Cholesterol↗
PubMed1999

Endovascular papillary angioendothelioma (Dabska tumor) of bone.

Endovascular papillary angioendothelioma, also known as Dabska tumor, is a rare vascular neoplasm that usually involves the skin or subcutaneous tissue of children. There have been no reported cases of this lesion occurring in bone. We report a Dabska tumor in the distal femur of a 45-year-old woman who, clinically and radiologically, was felt to have an osteoid osteoma. Histologic study of the lesion showed a hemangioma with budding fronds of endothelial cells, a feature characteristic of the Dabska tumor. We feel that the lesion arose in a pre-existing hemangioma, a hypothesis suggested in a few other case reports. Endovascular papillary angioendothelioma is a low-grade malignant neoplasm, although only one patient has died due to this lesion. Our patient is asymptomatic without evidence of recurrence 1 year post curettage.

Bone Neoplasms↗
PubMed1999

Osteosarcoma of the head and neck: a review of the Johns Hopkins experience.

OBJECTIVE: To determine factors including treatment modalities which influence survival in patients with osteosarcoma of the head and neck. STUDY DESIGN: Retrospective clinicopathologic study of 27 patients with osteosarcoma of the head and neck. METHODS: The clinical charts and pathology slides were reviewed on 27 patients who had osteosarcoma of the head and neck between 1946 and 1998. The following variables were examined for their effect on survival: age of diagnosis, site of tumor, presentation, race, sex, prior radiation exposure, retinoblastoma history, margin status, and method of treatment. RESULTS: The average age at the time of diagnosis of the patients was 37.6 years (range, 7-82 y). The sex distribution was similar with 14 male and 13 female patients. Eight of 27 patients had osteosarcoma of the mandible, 9 of 27 had osteosarcoma of the maxilla and paranasal sinuses, and in 10 of 27 patients osteosarcoma occurred elsewhere, including the temporal bones, occipital bones, and orbit. The overall 2-year survival was 66% with a 5-year survival rate of 55%. CONCLUSIONS: Positive surgical margins and a high tumor grade were found to have a statistically deleterious effect on overall survival. There was no detectable effect on survival of age, race, sex, prior radiation exposure, tumor site, and tumor cell type. It was not possible to differentiate between the different adjuvant treatment modalities because of the small numbers in the study.

Adolescent↗
PubMed1999

A 15-month evaluation of the effects of repeated subgingival minocycline in chronic adult periodontitis.

BACKGROUND: A double-blind, randomized, parallel, comparative study was designed to evaluate the long-term safety and efficacy of subgingivally administered minocycline ointment versus a vehicle control. METHODS: One hundred four patients (104) with moderate to severe adult periodontitis (34 to 64 years of age; mean 46 years) were enrolled in the study. Following scaling and root planing, patients were randomized to receive either 2% minocycline ointment or a matched vehicle control. Study medication was administered directly into the periodontal pocket with a specially designed, graduated, disposable applicator at baseline; week 2; and at months 1, 3, 6, 9, and 12. Scaling and root planing was repeated at months 6 and 12. Standard clinical variables (including probing depth and attachment level) were evaluated at baseline and at months 1, 3, 6, 9, 12, and 15. Microbiological sampling using DNA probes was done at baseline; at week 2; and at months 1, 3, 6, 9, 12, and 15. RESULTS: Both treatment groups showed significant and clinically relevant reductions in the numbers of each of the 7 microorganisms measured during the entire 15-month study period. When differences were detected, sites treated with minocycline ointment always produced statistically significantly greater reductions than sites which received the vehicle control. For initial pockets > or =5 mm, a mean reduction in probing depth of 1.9 mm was seen in the test sites, versus 1.2 mm in the control sites. Sites with a baseline probing depth > or =7 mm and bleeding index >2 showed an average of 2.5 mm reduction with minocycline versus 1.5 mm with the vehicle. Gains in attachment (0.9 mm and 1.1 mm) were observed in minocycline-treated sites, with baseline probing depth > or =5 mm and > or =7 mm, respectively, compared with 0.5 mm and 0.7 mm gain at control sites. Subgingival administration of minocycline ointment was well tolerated. CONCLUSIONS: Overall, the results demonstrate that repeated subgingival administration of minocycline ointment in the treatment of adult periodontitis is safe and leads to significant adjunctive improvement after subgingival instrumentation in both clinical and microbiologic variables over a 15-month period.

Adult↗
PubMed1999

Pathologic features in steroid and nonsteroid associated osteonecrosis.

Multiple pathophysiologies for osteonecrosis have been postulated and various associated risk factors defined for this disease. However, the pathologic findings of the end stage disease are thought to be similar in all patients. To the author's knowledge, there are no data in the literature comparing the pathologic characteristics of osteonecrosis in a quantitative manner between groups of patients with different associated risk factors. The current study examined the pathologic features of core decompression specimens from the femoral head in a group of patients with osteonecrosis associated with corticosteroid therapy and compared them with specimens from patients with osteonecrosis with no history of corticosteroid therapy. The study group comprised 65 patients (96 hips); 45 patients (68 hips) in the corticosteroid group and 20 patients (28 hips) in the noncorticosteroid group. In the corticosteroid group, 65% of dead bone was identified histologically (44 of 68) as compared with 46% (13 of 28) in the noncorticosteroid group. Specimens staged according to the histologic grading system of Arlet and Durroux revealed the corticosteroid group had a higher incidence of late stage lesions than did the noncorticosteroid group. This was found even though the two groups had similar radiographic staging distribution. The hips in patients who used alcohol were comparable pathologically to the hips in patients who used corticosteroids. This study emphasizes that the histologic features of necrosis and repair are similar in corticosteroid and noncorticosteroid osteonecrosis. However, there were differences in the distribution of viable bone and pathologic stage of the lesions in the two groups, suggesting a more rapid evolution of changes in the corticosteroid group.

Adult↗
PubMed1998

The pathology of transient regional osteoporosis.

Biopsy specimens from 19 patients with transient regional osteoporosis were studied. All patients presented with pain. There were nine patients with transient osteoporosis of the hip. Six of these specimens were therapeutic core biopsies, and three were femoral heads removed during total hip replacement. The other patients with osteoporosis in different locations had biopsies to rule out infection or neoplasm. Five of these patients had transient osteoporosis of the knee. Three had ankle involvement and two had involvement of the tibial shaft. Plain radiographs were available for study in all cases, and either a bone scan or an MRI was studied in each case. Except for one patient who was lost to follow-up, all had resolution of symptoms and radiographic changes. The histologic changes in the biopsies were distinctive, although they were present in varying degrees. There was edema and reactive bone formation in the marrow spaces. In addition, osteoclastic bone resorption was active in 14 of the 19 cases. Although lipid cysts were sometimes found in the marrow spaces, there was no evidence of fat necrosis or bone necrosis. The high bone turnover and absence of fat necrosis suggests that this disorder is a vasomotor response rather than an early stage of osteonecrosis. Awareness of these characteristic histologic changes should enable the pathologist to make a specific diagnosis of transient regional osteoporosis when a biopsy is required.

Adult↗
PubMed1997

Histopathologic correlates of a positive bone scan.

The accumulation of radioactive tracer is associated with specific histological changes. Awareness of these changes permits a more specific interpretation of a positive bone scan, especially when correlating the radionuclide image with the plain radiographs. Increased uptake in the flow phase of an imaging study usually corresponds to differentiated vascular spaces. In the blood pool phase, tracer accumulation is caused by neovascularity, a feature of reactive granulation tissue or neoplastic angiogenesis. In the delayed phase, tracer uptake is attributable to osteoid production. With plain radiographic correlation, the manner of osteoid deposition--remodeling, endochondral, reactive, or neoplastic--can be determined. The knowledge of these histological features may help the nuclear radiologist make the correct diagnosis.

Adult↗
PubMed1997

Bone histomorphometry in adults with type IA osteogenesis imperfecta.

A histologic and histomorphometric analysis was performed on undecalcified bone from 8 adult patients, ages 34 to 64 years, with Type IA osteogenesis imperfecta. Complete histomorphometric data, including static and dynamic parameters of bone remodeling, could be generated on 6 patients, and partial data were obtained from the other 2 patients. Findings in some patients of reduced eroded surfaces and reduced osteoid surfaces suggested low bone turnover. Other findings included normal or slightly reduced labeled surfaces, slightly reduced bone formation rate, decreased cortical thickness, and decreased bone volume. Histologic examination results showed lamellar bone with mature cortical Haversian systems. Trabeculae showed qualitatively normal connectedness despite low trabecular volume. The finding of normal or reduced bone turnover in adults with Type IA osteogenesis imperfecta has not been reported. Earlier histomorphometric studies, performed without correlation with a specific age or phenotype, indicated high bone turnover. The present study suggests that future research should correlate histopathologic changes with specific phenotypes. The finding of normal or slightly reduced bone turnover in Type IA osteogenesis imperfecta may have important therapeutic implications for this phenotype.

Adult↗
PubMed1997

Benign and malignant musculoskeletal masses: MR imaging differentiation with rim-to-center differential enhancement ratios.

PURPOSE: To assess the diagnostic potential of the rim-to-center differential enhancement ratio in the magnetic resonance (MR) imaging differentiation of benign from malignant musculoskeletal masses. MATERIALS AND METHODS: Dynamic gadolinium-enhanced fast multiplanar spoiled gradient-recalled acquisition in the steady state imaging was performed to evaluate 17 one and soft-tissue masses (10 malignant, seven benign) in 14 patients. The rim-to-center differential enhancement ratio was determined from images at the maximal enhancement rate. The difference in differential enhancement ratios between benign and malignant masses was evaluated and compared with the maximum rate of enhancement for each mass. RESULTS: Nine of 10 malignant masses showed rapid rim enhancement with delayed central fill-in. This enhancement pattern was absent in benign masses. The average rim-to-center differential enhancement ratio was 0.64 +/- 0.26 for malignant masses and -0.16 +/- 0.33 for benign masses (P < .001). This difference was statistically significant. The average maximum rate of enhancement was 3.41%/sec +/- 2.20 for malignant masses and 2.74%/sec +/- 2.46 for benign masses (P > .05). CONCLUSION: Intratumoral enhancement patterns of malignant and benign masses differ because of differences in vascular architecture. These preliminary results suggest that the rim-to-center differential enhancement ratio has potential as an additional parameter for the MR imaging differentiation of indeterminate musculoskeletal masses.

Adolescent↗