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Biomedical subjects

F H Sim

Publications and source records attributed to F H Sim.

At least 217 records · Page 12Linked to original sources
PubMed1979

Osteosarcoma with small cells simulating Ewing's tumor.

Twenty-four patients who had osseous lesions with histological features of both Ewing's sarcoma and osteosarcoma were studied. Because of their appearance, these lesions have been labeled small-cell osteosarcomas. They appear to represent a definite histological entity and the prognosis may be worse for these lesions than for conventional osteosarcomas. It is most important not to misdiagnose this tumor as Ewing's sarcoma because it appears not to be radiosensitive. Radical surgery and modern adjuvant chemotherapy seem to offer the best chance of cure.

Adolescent↗
PubMed1979

Total joint arthroplasty. Applications in the management of bone tumors.

Limb-saving resection has become a valid alternative to amputation in carefully selected patients with bone tumors. As interest grows in this technique, efforts continue to improve our methods of bone and joint reconstruction to restore a functional extremity. Previously there was little interest in this form of treatment despite a limb-saving potential, because of inadequate methods of skeletal reconstruction. The purpose of this paper is to review these previous methods and to outline our present approach to the problem.

Adolescent↗
PubMed1979

Prosthetic replacement of the knee and a large segment of the femur or tibia.

Total replacement of the knee and of a long segment of the femur or tibia provided functional recovery of the knee joint in thirteen patients in whom the length of the bone replaced ranged from seventy-five to 150 millimeters. Nine patients had benign bone tumors, three had malignant lesions, and one patient had salvage of a failed total knee arthroplasty, associated with loss of bone structure. After follow-up of two years or more, all patients had a stable extremity, excellent relief of pain, and a useful range of motion, although one patient required revision for loosening.

Adolescent↗
PubMed1978

A prospective randomized study of the efficacy of routine elective lymphadenectomy in management of malignant melanoma. Preliminary results.

To determine whether immediate or delayed lymphadenectomy is more beneficial than none in cases of localized (stage I) melanoma, we undertook in 1972 a prospective randomized study. Patients with midline trunk lesions were excluded as well as patients with lesions situated directly over the node-bearing area. In addition, because of the low risk of metastasis, the protocol was changed to exclude level 2 lesions. Of the 173 patients studied, 63 were randomized to no lymphadenectomy, 56 to delayed (3 months) lymphadenectomy, and 54 to immediate lymphadenectomy. None of these regimens differed significantly from the others in its effect on length of survival or interval to metastasis. And of the 110 patients who underwent elective lymphadenectomy, 103 were without nodal involvement. Our preliminary conclusion is that elective node dissection is not beneficial in management of melanoma. However, disease progression was advanced significantly by age of the patient (greater than 60 years) and by invasiveness (level 4 or 5) and thickness (greater than 1.5 mm) of the melanoma.

Adult↗
PubMed1978

Adjuvant radiation therapy for regional nodal metastases from malignant melanoma: a randomized, prospective study.

After nodal metastasis from malignant melanoma, approximately 80% of patients die from disseminated disease. To clarify the role of radiation therapy (XRT) following node dissection. 56 patients with biopsy-proven nodal metastasis participated in a randomized, prospective clinical trial which compares radiation therapy to the regional lymph node area following lymphadenectomy (27 patients) with lymphadenectomy alone (29 patients). Interesting differences in the survival curves (p = 0.09) and in the disease-free interval curves (p = 0.08) for the two treatment groups proved to be attributable to imbalances in the age and nodal distributions in the treatment groups. Covariate analysis identified age and sex as the factors having the most significant (p less than 0.04) effect on survival and identified the number of positive nodes as the covariate having the most significant (p less than 0.02) effect on disease-free interval. Treatment did not have a significant effect upon survival or disease-free interval.

Clinical Trials as Topic↗
PubMed1978

Surgical treatment of osteogenic sarcoma at the Mayo clinic.

Osteogenic sarcoma continues to present a tremendous therapeutic challenge. Until recently, treatment has continued at a relatively unsophisticated level. Although amputation, usually at a cross-bone level with a safe margin above the lesion, continues to be the treatment of choice, increased interest is being demonstrated in radical en bloc limb-saving resections. Modern joint implants are proving effective in restoring the osseous integrity and joint function after the resection.

Amputation, Surgical↗
PubMed1978

Resection of pulmonary metastatic osteogenic sarcoma in children.

Over a three year period, 28 children or young adults up to 20 years of age underwent 60 thoracotomies for pulmonary metastatic osteogenic sarcoma. These patients also received adjuvant chemotherapy. Sixteen of the 28 patients are currently alive and 13 of these are free of disease. The patients have been followed for 6 to 48 months after the initial thoracotomy; median survival is 25 months. Actuarial survival curves produced a 4 year survival of 57%. Although a tumor-free interval of more than 1 year greatly enhanced survival, three patients survived with tumor-free interval of 6 months or less. Patients with disease confined to one lobe at the initial thoracotomy did very well, and yet survivors were seen when disease involved more than one lobe or was bilateral. An aggressive surgical approach toward the pulmonary metastases thus appears to be justified.

Adolescent↗
PubMed1977

Multicentric giant-cell tumor of bone.

The presence of more than one distinct giant-cell tumor in the same patient is rare; seven cases have been reported in the literature. The present series involves eleven patients with thirty-five individual tumors. Multifocal giant-cell tumors may pose a diagnostic problem. It is difficult to distinguish a multicentric giant-cell tumor from a primary giant-cell tumor with metastatic spread. This problem is magnified when the second lesion is not noted at the onset or is metaphyseal in location. Moreover, these lesions present a therapeutic challenge to the surgeon. Multiple lesions tend to exhibit the same aggressive clinical behavior as a solitary giant-cell tumor. A high recurrence rate after curettage indicates that aggressive surgical management is necessary.

Adolescent↗
PubMed1977

Extra-articular synovial chondromatosis.

Four patients with extra-articular synovial chondromatosis and one patient with combined intra-articular and extra-articular involvement are described. In all five patients the lesion was anomalously located (knee, shoulder, hip, and ankle). The lesion usually occurs in the hands and feet. Accurate diagnosis is important, because if the synovial origin of the cartilaginous proliferations is ignored, the evidence of cellular activity may lead to an erroneous diagnosis of chondrosarcoma. All five patients had a benign clinical course.

Adult↗
PubMed1976

Metastatic tumors to the bones of the foot.

Information on lesions that are metastatic to the bones of the feet is limited. Review of the literature revealed only 17 cases, nine of which were confirmed histologically. Our series involved the clinical records, roentgenograms, and pathologic specimens in eight cases of biopsy-proven metastatic involvement of the bones of the foot. In three additional cases, there was clinical and roentgenographic evidence of metastatic osseous foot lesion but biopsy was not done to provide histiolgic confirmation. Genitourinary malignancies tended to be associated with metastasis to the bones of the feet, the calcaneus being the commonest site of involvement. Although metastatic lesions of the foot are rare, foot pain may be suggestive of an occult carcinoma. Foot pain was the initial presenting complaint in five of our eight cases. The pathogenesis of these distal metastatic lesions remains obscure. Specific problems in management are associated with osseous metastases of the foot.

Adult↗
PubMed1976

Methylmethacrylate as an adjunct in internal fixation of pathological fractures. Experience with three hundred and seventy-five cases.

In 323 patients with 375 pathological fractures or impending fractures, local tumor resection and internal fixation supplemented by intramedullary methylmethacrylate proved highly successful. One hundred and thirty-nine patients had metastases from breast carcinoma; 142, metastases from other tumors; and forty-two, myeloma or lymphoma. The mean survival for the 210 patients who had undergone operation two years or more before final evaluation was 15.4 months. Ninety-four per cent of the patients who were ambulatory before fracture regained the ability to walk. Eighty-five per cent had excellent or good pain relief and in only five was pain relief rated poor. There were four failures of fixation and six functionally poor results. Twenty patients died within four weeks of operation, but the remaining patients benefited from the procedure in terms of pain relief, improved mobility, and ease of nursing care.

Acetabulum↗
PubMed1976

Total hip arthroplasty in Paget's disease of the hip.

For thirty-two patients with Paget's disease of the pelvis, mechanical disruption of the hip joint caused sufficient pain and disability to require total hip-replacement arthroplasty. Three of the patients had had fractures of the femoral neck. No unusual complications were encountered and the results were excellent.

Aged↗
PubMed1976

Chondrosarcoma: clear-cell variant. A report of sixteen cases.

Of sixteen adult patients with clear-cell chondrosarcoma, ten were men. The tumor usually involved the proximal part of the femur or humerus. Roentgenographically, the lesion was usually well defined and indistinguishable from chondroblastoma. Serial roentgenograms occasionally showed malignant progression of the lesion. Histologically, benign giant cells and cells with clear cytoplasm were always present, and areas of conventional chondrosarcoma were seen in about half the cases. Excision usually resulted in recurrence; resection seemed to be curative. Four of the sixteen patients died as a result of the tumor. Clear-cell chondrosarcoma should be distinguished from chondroblastoma and treated more aggressively.

Adult↗