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Biomedical subjects

E R Mindell

Publications and source records attributed to E R Mindell.

At least 19 recordsLinked to original sources
PubMed2001

Infection following knee arthroscopy.

Arthroscopy of the knee is not a risk-free procedure. Although rare, numerous complications have been reported in the literature. Fortunately, infection is a rare complication following arthroscopy, which, when treated, usually results in a benign outcome. We present the first reported case of Candida albicans infection following routine arthroscopy of the knee, which eventually resulted in a knee fusion. A review of infections that can occur after knee arthroscopy and their treatment is also presented. This and other potential complications should be considered when performing knee arthroscopy.

Adult↗
PubMed2000

Clinical importance of late recurrence in soft-tissue sarcomas.

BACKGROUND AND OBJECTIVES: Soft-tissue sarcomas (STS) represent a diverse histologic group of malignancies at risk for local and distant failure. We studied the impact of late (5 or more years) vs. early recurrence (less than 5 years) on subsequent outcome. METHODS: Four hundred sixty-eight patients with STS treated between 1962 and 1992 were evaluated for late (n = 39; 8%) or early (n = 253; 54%) recurrence. Clinical and pathologic factors were reviewed. Survival data were analyzed by the Kaplan-Meier method and the log-rank test. RESULTS: Of the 39 patients with a late recurrence (median follow-up 156 months), 18 patients had local recurrence, 7 patients developed distant recurrence, and 14 patients had local and distant recurrence. Thirty patients with late local and/or distant recurrence underwent complete or wide excision (n = 16), amputation (n = 4), or local resection (n = 10). The overall 5-year survival rate following late recurrence was 61%. The 5-year overall survival rate was statistically better for patients with a late local recurrence alone than for patients with distant failure, 94% vs. 36%, respectively (P = 0.003). Neither the site of the primary STS, age, primary margin status, nor histology had any effect on subsequent local or distant failure and subsequent survival. CONCLUSIONS: These data suggest that an aggressive approach is appropriate in patients who present with late recurrence (more than 5 years) following treatment of the primary STS. Impressive survival rates can be achieved in the treatment of local recurrences.

Adult↗
PubMed2000

Ewing's sarcoma of the pelvis. Long-term survival and functional outcome.

Fifty patients with Ewing's sarcoma of the pelvis were treated using a multidisciplinary approach; followup of surviving patients averaged 137 months (range, 40-276 months). The addition of surgical resection to the multidisciplinary treatment for all patients was associated with improved survival compared with survival of patients treated with chemotherapy and radiation therapy alone; the addition of surgery to the treatment regimen of 37 patients without metastases also was associated with improved survival. There were no significant differences between the surgical and nonsurgical groups in terms of tumor size, stage of disease, patient age, duration of symptoms before diagnosis, or anatomic site. Surgery was used more often in recently treated patients, but the year of diagnosis and treatment did not significantly affect overall survival, secondary to large confidence intervals. The Short Form-36 and the Musculoskeletal Tumor Society functional evaluation instruments showed a superior level of function in the nonsurgical group, but this difference was not statistically significant. There have been many advances in the treatment of patients with Ewing's sarcoma during the past 3 decades, resulting in improved survival for patients with Ewing's sarcoma of the pelvis. The addition of surgery significantly improved survival and did not show a significant difference in functional outcome.

Adolescent↗
PubMed1994

Relationship between osteofibrous dysplasia and adamantinoma.

The records and computer files of 32 patients treated at 1 institution for ossifying fibroma, fibrous dysplasia, osteofibrous dysplasia-like adamantinoma, or adamantinoma of the tibia were reviewed. Nineteen patients had their diagnosis changed, either because of a recurrence or through review of their histology. Six of the 9 patients who had a typical adamantinoma and 6 of the 10 patients who had an osteofibrous dysplasia-like adamantinoma had a diagnosis of 1 of the benign conditions before their adamantinoma was recognized. Only 6 patients actually had osteofibrous dysplasia. Three patients required a resection, but only 1 of the other 3 has been observed > 5 years. This review suggests that many patients with a diagnosis of fibrous dysplasia or osteofibrous dysplasia of the tibia actually have an adamantinoma, and that osteofibrous dysplasia is often a locally aggressive lesion that progresses until it is widely resected. In addition, osteofibrous dysplasia and adamantinoma appear to be related, and osteofibrous dysplasia may be a precursor of adamantinoma.

Bone Diseases, Developmental↗
PubMed1991

Observations on massive retrieved human allografts.

Radiographic and histological studies of sixteen massive retrieved human allografts were carried out after the allografts had been in situ for four to sixty-five months. The studies demonstrated that union between the allograft and the host took place slowly at cortical-cortical junctions by the formation of an external callus derived from the cortex of the host, and it took place more rapidly at cancellous-cancellous junctions by internal callus advancing from the host into the allograft. Internal repair took place very slowly, was confined to the superficial surface and the ends of the graft, and had involved only 20 per cent of the graft by five years. The deep unrepaired portions of the graft retained their architecture, and where bone cement had been used to fix a prosthetic stem or an intramedullary rod to the allograft, there was no evidence of resorption of bone or loosening of the device. Soft tissues of the host became attached to the graft by deposition of a thin seam of new bone on the surface of the graft. A previous fracture of two grafts had healed before the time of retrieval. Analysis of the articular cartilage revealed no evidence that any chondrocytes had survived, even when the graft had been cryoprotected before it was preserved by freezing. The necrotic cartilage functioned well for as long as five years, and as it degenerated, it was covered by a pannus of fibrovascular reparative tissue. Two allografts that had been removed because of rejection were surrounded by an envelope of chronic inflammatory tissue that prevented union, adherence of soft tissue, and internal repair. Internal repair was more advanced about sites of fracture and adjacent to recurrent tumors than in other portions of the graft. These findings suggest that large frozen allografts in humans are osteoconductive rather than osteoinductive.

Adolescent↗
PubMed1986

Adjuvant adriamycin and cisplatin in newly diagnosed, nonmetastatic osteosarcoma of the extremity.

Twenty-two patients with newly diagnosed nonmetastatic osteosarcoma of the extremity were treated with an adjuvant chemotherapeutic regimen consisting of Adriamycin (Adria Laboratories, Columbus, Ohio) and cisplatin. Fourteen of the 22 patients remain continuously disease free for 65+ to 113+ months, with a median time on study of 70+ months. The 72-month disease-free survival estimate is 64%. Pulmonary metastases occurred in six patients, an isolated stump recurrence was seen in one patient, and one patient had a local recurrence following a limb-salvage procedure. For those patients in whom pulmonary metastases developed, the onset was late in three of six, and the number of metastases was three or fewer in all patients. Two patients with pulmonary metastases and one with a stump recurrence have apparently been salvaged, thus resulting in a 77% 72-month survival. Toxicity observed in patients treated with this regimen was in keeping with previous reports. This chemotherapeutic regimen is effective in the adjuvant therapy of nonmetastatic osteosarcoma of the extremity. It should be incorporated into other adjuvant protocols in an effort to continue to improve the outcome in patients with osteosarcoma.

Adolescent↗
PubMed1986

Ewing's sarcoma of the scapula with metastases to the lung and eye.

A small, round cell tumor of the left scapula was found in a 3-month-old female Caucasian child. The histology was consistent with Ewing's sarcoma. Subsequently, a solitary pulmonary metastasis was excised. Thirty-one months after diagnosis, the child presented with leukokoria and a solitary pleural metastasis. The histology of both was identical to that of the original scapular tumor. G-banded karyotypes of the pulmonary metastasis and the ocular tumor revealed the presence of a balanced translocation, 46,XX, t(11;22)(q24;q12), which supported the original diagnosis of Ewing's sarcoma.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1985

The role of social support systems in adolescent cancer amputees.

Amputation is often a component in the treatment of bone tumors such as osteogenic sarcoma, which is most prevalent in the adolescent age group. Adaptation to cancer and loss of a limb requires a significant multidimensional effort. To examine the role of social support systems, 27 adolescents who had undergone amputations for cancer were interviewed. Inquiries were made regarding patients' perceived social support providers and the impact of amputation upon their lives and independence. Parents, especially mothers, were perceived as realistic and most helpful at the time of surgery (80%), followed by professional hospital staff (59.3%), and siblings (59.3%). Friends of patients were less helpful, as many reported their friends felt sorry for them (65.4%), avoided them (33.3%), or drifted away (40%). Only 7.4% of the patients had a clear preference to be associated with other amputees. This study details other preferences and difficulties encountered by the adolescent amputees and the role of support systems in their adaptation to their disease and amputation.

Adolescent↗
PubMed1985

Primary malignant tumors of the upper extremity: retrospective analysis of one hundred twenty-six cases.

We retrospectively evaluated 126 patients with primary sarcomas of bone (45) and soft tissue (61) in the upper extremity principally to evaluate the effectiveness of the Musculoskeletal Tumor Society staging system in predicting treatment outcome and to note differences between bone and soft tissue sarcomas. Patients were followed 2 to 11 years from diagnosis. The mean survival from treatment onset was 49 months (4 to 144 months). A strong statistical relationship (p less than 0.05) between anatomic location (above/below elbow) and surgical stage (stage I/II, A/B) was demonstrated. The type of primary operation and subsequent incidence in local tumor recurrence were found to be statistically different. Seventy percent of soft tissue tumors that metastasized first recurred locally, but such a strong association was not evident for bone. Development of metastases significantly shortened survival. Radical primary excision of soft tissue malignancies sharply reduced local recurrence and thereby diminished metastatic risk; similar findings were not present for bone malignancies. This study suggests that the Musculoskeletal Tumor Society staging system is valid and should be applied to these infrequent malignancies, permitting future statistical comparisons.

Adolescent↗
PubMed1982

Adolescent adjustment to amputation.

We investigated the psychological effects of amputation on adolescent patients by interviewing 27 persons who had a limb amputation because of cancer during their adolescence and compared them to data obtained from eight patients with amputations due to trauma at similar ages. In cancer patients, mobility-related activities and social matters including relations with peers and the opposite sex and self-consciousness were of paramount concern. All cancer patients considered themselves functionally independent and 67% had little or no concern for the future. While malignancy and amputation had a significant impact on the patients' lives, the vast majority had a positive view of life and 85% were found to have what we assessed as adequate overall adjustment. Individual variables examined included marital and child-bearing patterns, educational attainments, vocational attainments, perceived parental and peer support, adaptation to prosthesis, and variables relating to general outlook on life and psychological adjustment. Our results suggest that the patients who have had amputations due to malignancy differ from traumatic amputees in their adjustment to amputation, with cancer patients showing, in many instances, evidence of better adaptation to disability. This may in part be due to different backgrounds and social orientation of traumatic amputees. We found the majority of cancer amputees to adjust well to their circumstances and to report leading full and productive lives.

Adolescent↗
PubMed1982

Remodeling of large, persistent bone defects.

Large, standard, persistent, metaphyseal defects were surgically produced in adult dogs' distal femora to simulate clinical defects. Dogs were killed at intervals after surgery ranging from zero to 48 weeks. Biomechanical testing revealed that initially, the torsional strength was reduced to 44% of normal. A gradual return of torsional strength to 90% of normal occurred by 48 weeks. Roentgenographic and histologic studies of the animals and specimens correlated remodeled bone formation with increasing strength. In a small group of animals, suspected microfractures occurred early, induced bone regeneration, and resulted in accelerated recovery of strength.

Animals↗
PubMed1981

Adjuvant adriamycin and cis-diamminedichloroplatinum (cis-platinum) in primary osteosarcoma.

Twelve consecutive patients with osteosarcoma who were without evidence of metastases were treated with Adriamycin and cis-platinum in an adjuvant fashion. The primary lesion was in the distal femur in five patients, proximal tibia in three, and one each in the proximal femur, proximal humerus, sacrum, and a previously irradiated orbit. Surgery consisted of amputation in eight, limb-salvage procedures in two, and regional resections in the patients with orbital and sacral lesions. Postoperatively, Adriamycin at 30 mg/m2/d, for three days alternated every three weeks with cis-platinum, 100 mg/m2, once daily or 60 mg/m2/d, for two days i.v. drip forced i.v. fluid diuresis. Adriamycin was given to a total dose of 540 mg/m2. Ten of 12 patients remain continually disease-free with a median time on study of 23+ months (range 12+-41+ months). Local recurrences, without evidence of metastatic disease, occurred in the patient with the orbital lesion and the patient who underwent the regional resection for the lesion of the proximal humerus at 20 and 17 months from diagnosis, respectively. Nine patients are off all chemotherapy from 6+ to 33+ months (median 22+ months). Administration of cis-platinum was limited to eight courses because of renal and ototoxicity. Despite appreciable toxicity, this chemotherapeutic regimen appears to be a highly effective adjuvant in the management of primary nonmetastatic osteosarcoma.

Adolescent↗
PubMed1981

Chordoma.

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Bone Neoplasms↗
PubMed1979

Primary Ewing's sarcoma of the sternum: a case report.

A 12 1/2-year-old female presented with Ewing's sarcoma of the manubrium sterni which extended into the anterior mediastinum. At presentation there was no evidence of metastatic disease. Her initial treatment consisted of radiation therapy and chemotherapy. The residual tumor was subsequently resected and the sternal defect was repaired with Marlex mesh. Postoperatively, she was maintained on chemotherapy consisting of BCNU, cyclophosphamide, and adriamycin. The adriamycin was discontinued after she developed sterile fibrinous pericarditis. She remains free of her disease two years after diagnosis. Although extremely rare, Ewing's does occur in the sternum and this area is amenable to wide local resection without severe functional disability.

Bone Neoplasms↗
PubMed1978

cis-Dichlorodiammineplatinum (II) in advanced osteogenic sarcoma.

Eight patients with advanced metastatic osteogenic sarcoma were treated with cis-dichlorodiammineplatinum(II) (DDP). Prior to DDP, seven patients had amputations and all had received adjuvant adriamycin (ADR) therapy. In addition, prior to DDP, six patients had received high-dose methotrexate. There was one complete response (pulmonary metastases) and four partial responses (three metastases in the lungs and one in the bone). One additional patient, with local recurrence of osteogenic sarcoma of the mandible following initial resection and adjuvant ADR, was retreated with surgery and DDP and is disease-free for greater than 3 years. The cumulative dose ranged from 300 to 660 mg/m2. Toxicity included irreversible kidney damage in two patients, transient severe hematologic suppression in two patients, and nausea and vomiting in all patients. DDP is a new effective agent in the treatment of osteogenic sarcoma.

Adolescent↗