Biomedical subjects
Publications and source records attributed to H M Dick.
Myoelectric upper-extremity prostheses, which have opened up a new world of freedom and function for upper-extremity amputees, are examined in terms of patient acceptance, ease of use, and durability of the unit.
Primary malignant tumors of the bone are among the most rare tissue type and more rare in the acral parts. The authors recommend the use of the Musculoskeletal Tumor Society Grading System for standardization of these rare tumors in the hand.
A study of HLA-A and B antigens in 248 patients with biopsy diagnosed alcoholic liver disease was conducted to examine for a genetic predisposition to alcohol related liver injury. No statistically significant differences were established for 8 HLA-A and 16 HLA-B antigens between normal healthy controls (n = 342) and patients with alcoholic fatty liver (n = 86), alcoholic hepatitis (n = 63), active alcoholic cirrhosis (n = 64) and inactive alcoholic cirrhosis (n = 35). It is concluded that no HLA-A or B locus genetic susceptibility to alcoholic related injury could be shown.
Synovial sarcoma of the hand is a very rate tumor in an equally unusual location with a difficult histology of a fibrosarcoma combined with synovial-like areas that resemble joint endothelial lining. It has a poor prognosis prior to the current combined treatment of surgical ablation, radiation to the surgical field, and chemotherapy for microscopic metastases. It has an unexplained natural history of very late recurrence and distant spread, often 10 to 20 years following primary treatment.
Malignant fibrous histiocytoma of the hand is a unique tumor in a rare location with a characteristic histology of fibrous material in a storiform pattern that is diagnostic in appearance. It has a second type of tumor consisting of histiocytic appearance without fibrous tissue. It is most difficult to treat and often requires ablative surgery combined with postoperative radiotherapy and chemotherapy for long-term survival.
Blastomycosis osteomyelitis frequently complicates systemic blastomycosis, but it is unusual as an isolated osteolytic lesion in the asymptomatic patient. An isolated blastomycotic osteomyelitis of the distal radius was the initial manifestation of blastomycosis in a healthy young man. The lesion was originally interpreted as a sarcoma. Fungal osteomyelitis must be differentiated from radiologically similar bone neoplasms.
HLA typing for antigens of the A, B, C, and DR loci was carried out on lymphocytes from a haemophilic (Type A) family which included four siblings with arthritis. No single haplotype was found to relate to the presence of haemophilia or haemophilic arthritis.
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Tooth-forming ovarian teratomas provide a unique opportunity to observe the effect(s) of the tumor environment on developing dental structures. Histologic examination of two such teratomas showed essentially normal formation of dental structures in one and pronouncedly aberrant morphodifferentiation of dental tissues in the other. The macroscopic examination of a total of twenty-five teeth from eight additional teratomas showed most teeth to have premolar or molar forms. Most teeth were not distinctly deciduous or permanent but had intermediate shapes. The teeth within a tumor tended not to form normal morphologic sequences. It is concluded that dental structures in ovarian teratomas are products of normal genetic/epigenetic events modified to a greater or lesser degree by unknown factors in the tumor environment.
Four cases of lipofibromatous infiltration of the median nerve with long-term follow-up (average 11 years) are reported. Progressive compromise of median nerve function has been noted. Initial treatment considerations should be directed toward biopsy and alleviation of the compression neuropathy. The role of microsurgical debulking procedures remains unclear at this time.
In a study of the clinical and immunogenetic profiles of 17 patients with rheumatoid arthritis and thrombocytopenia (platelet count less than 150 000/mm3 (150 x 10(9)/l)) due to gold therapy two clinical patterns were distinguished without knowledge of HLA type: group I, an early precipitous thrombocytopenia (10 patients), and group II, a less dramatic fluctuant fall (seven patients). In group I patients the clinical and laboratory features suggested an immune mediated, peripheral destruction of platelets, and all patients in this group were found to be HLA-DR3 positive. Two patients subsequently received penicillamine without toxicity. In group II the basis of thrombocytopenia appeared to be different, and only two patients in this group were HLA-DR3 positive. All group II patients had received penicillamine; four developed a thrombocytopenia. Mechanisms of toxicity in both groups are discussed. It would appear that HLA typing in unlikely to help in predicting all those patients at risk of toxicity during chrysotherapy.
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An Indian atopic child presented with benign chronic bullous disease of childhood (BCBDC). HLA grouping did not show the typical finding of HLA B8 which questions the value of HLA typing in this condition.
Malignant fibrous histiocytoma (MFH) is a pleomorphic sarcoma that is uncommon in children. It most frequently arises from the soft tissues; however, it has been recently established that primary bone MFH also exists. Surgical resection or amputation is the cornerstone of treatment for MFH of bone. But, with this modality of therapy alone the majority of patients develop either distant metastases or local recurrence. This study reports on three adolescent girls with MFH of bone who were successfully treated with radical resection and 18 months of adjuvant chemotherapy with vincristine, high dose methotrexate, Citrovorum Factor rescue, and Adriamycin. All three patients remain disease-free for a follow-up period of 42-48 months. The current regimen was well tolerated. Morbidity was minimal, with no patient developing any significant drug-related complications. The adjuvant chemotherapy regimen described appears to be effective in prolonging survival in patients with MFH of bone and appears to warrant further study in additional patients.
A case of osteoid osteoma occurring in the distal femoral epiphysis of an 8-year-old girl is presented. The rare occurrence of this lesion is discussed together with the importance of establishing a definitive diagnosis. The surgical approach and role of the image intensifier are presented.
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