Search PubMed⌕ Search

Biomedical subjects

H Thomas Temple

Publications and source records attributed to H Thomas Temple.

At least 19 recordsLinked to original sources
PubMed2007

Case report. Granular cell tumors of extremities: comparison of benign and malignant variants.

Granular cell tumors are uncommon soft tissue neoplasms that arise from cells of neural origin. We present three patients with this rare tumor: one with a benign tumor, one with a malignant tumor, and one with a histologically benign tumor that later metastasized to the lung. We studied the difficulty in differentiating between the benign and malignant variants using only histology. We also compared the clinical, radiographic, and pathologic features and the criteria for malignancy, natural history, and prognosis.

Adult↗
PubMed2006

Salvage of failed massive allograft reconstruction with endoprosthesis.

UNLABELLED: A subset of osteoarticular allograft reconstructions after tumor resection ultimately will fail in patients achieving long-term survival. There are several alternative surgical approaches to revising these reconstructions. We retrospectively evaluated the outcome of 20 patients who had allograft reconstruction with a modular endoprosthesis. All patients had a failed massive allograft (average length, 15.7 cm) after tumor resection about the shoulder and knee. The reasons for original allograft failure were fracture (14 patients), infection (five patients), and both (one patient). Followup of the patients averaged 159.7 months (range, 63-293 months) after allograft reconstruction and 77 months (range, 24-234 months) after endoprosthetic revision. The average number of operative procedures each patient had was 4.1 (range, 2-15 procedures). Two patients had amputations for resistant periprosthetic infections. A successful revision procedure was accomplished in 80% of the patients, and 90% of the patients retained functional limbs at recent followup. The predicted 5-, 10-, and 15-year survivals were 92%, 55% and 28% respectively. Musculoskeletal Tumor Society scores averaged 76% (range, 60-93.3%). When used to salvage massive allograft failure from infection and fractures, endoprosthetic revision preserves limb function with minimal complications. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2006

Distal femur replacement is useful in complex total knee arthroplasty revisions.

UNLABELLED: Revision total knee arthroplasty can be considerably more difficult in cases involving severe bone loss, complete absence of collateral ligaments, and persistent periprosthetic supracondylar femoral fractures. Modular segmental endoprosthetic distal femur replacement is a limb salvage option when other surgical options are unfeasible. The clinical performance of rotating hinge knee prostheses has greatly improved with the evolution of second and third generation designs. The increased freedom of rotation decreases the prosthetic bone stresses and the longevity. While designs have improved, the prostheses still do not match the function and longevity of condylar components with approximately a 90% survivorship at 20 years. The modular endoprosthesis rotating hinge knee prosthesis is useful for total knee arthroplasty revision in patients with inadequate bone stock, ligamentous instability, or difficult supracondylar femur fractures, especially in low demand elderly patients. LEVEL OF EVIDENCE: Therapeutic study, level V (expert opinion). See Guidelines for Authors for a complete description of levels of evidence.

Aged↗
PubMed2006

Differentiating clinical and radiographic features of enchondroma and secondary chondrosarcoma in the foot.

BACKGROUND: Enchondroma is the most common benign tumor of the bones of the foot. Chondrosarcoma in this area is relatively rare with malignant transformation from enchondroma occurring rarely. In contrast to similar tumors in the appendicular skeleton, it is difficult to distinguish between these two tumors when they occur in the foot. METHODS: We reviewed the medical records and radiographs of all patients with enchondroma and chondrosarcoma arising from enchondroma (secondary chondrosarcoma) from the radiologic archives at the Armed Forces Institute of Pathology (AFIP) and identified those patients with tumors involving the bones of the foot. There were 755 patients with enchondroma of which 34 (4.8%) involved the foot; there were 340 patients with secondary chondrosarcoma and 14 (4.1%) involved the foot. We compared clinical and radiographic features of both these lesions. We also compared interobserver differences not only for diagnosis but also for the presence of scalloping, fracture, cortical destruction, and mineralized matrix. RESULTS: Size and location were statistically significant variables differentiating the two tumors (p = 0.03). Enchondromas had a mean size of 2.7 cm(2). Lesions that occurred in the hindfoot and midfoot were more likely to be malignant compared to those in the forefoot. In comparing interobserver reliability, most disagreement occurred regarding the presence or absence of matrix with the examiners concurring only 51% of the time. With regard to diagnosis, the examiners' accuracy was 71% and 80%. Their accuracy increased only to 83% when they agreed. CONCLUSION: Our findings suggest that it is difficult to differentiate enchondroma from secondary chondrosarcoma in the foot. Concern for malignant change is warranted for cartilage bone tumors of the foot if they exceed 5 cm(2), or if they arise in the midfoot or hindfoot. In these cases, we recommend either biopsy or close clinical followup.

Adult↗
PubMed2006

Value of radiographs in the initial evaluation of nontraumatic adult heel pain.

BACKGROUND: Adult patients with nontraumatic plantar heel pain often present to orthopaedic surgeons for evaluation. A thorough history and physical examination are often sufficient for diagnosis, yet radiographs usually are ordered during the initial evaluation. The purpose of this study was to evaluate the value and cost-effectiveness of these radiographs. METHODS: A retrospective chart and radiographic review of 157 consecutive adults (215 heels) presenting with nontraumatic heel pain was done to evaluate the utility of routine radiographs in the initial evaluation. RESULTS: The most common diagnosis was plantar fasciitis (80.9%, 174 of 215). Radiographs were normal in (17.2%, 37 of 215), and incidental radiographic findings were observed in 81.4% (175 of 215). The most common incidental findings were plantar calcaneal spurs (59.5%, 128 of 215) and Achilles spurs (46.5%, 100 of 215). Only (2%, 4 of 215) of all patients had abnormal findings that prompted further evaluation. CONCLUSIONS: Routine radiographs are of limited value in the initial evaluation of nontraumatic plantar heel pain in adults and were not necessary in the initial evaluation. Radiographs should be reserved for patients who do not improve as expected or present with an unusual history or confounding physical findings.

Adolescent↗
PubMed2006

Oncologic and functional outcome following sacrectomy for sacral chordoma.

BACKGROUND: Sacral chordoma is a rare, low to intermediate-grade tumor that poses substantial challenges in terms of timely diagnosis and adequate treatment. Few studies have examined the oncologic and functional outcomes of patients treated for sacral chordoma. METHODS: The clinical records of sixteen patients who had undergone sacrectomy for chordoma between 1985 and 2001 were evaluated retrospectively. All patients underwent resection by means of a sequential combined anterior and posterior approach. Patients were followed clinically at six-month intervals following recovery from the index surgical procedure. The disease onset, treatment, hospital stay, recurrence rates, survival, adjuvant therapy, functional outcome measures, and complications were evaluated. RESULTS: The average age at the time of diagnosis was sixty-one years. The mean tumor size was 15.2 cm in diameter, and all patients had a resection involving S1 or S2. The mean duration of follow-up was sixty-six months, and the tumor recurred in twelve of the sixteen patients. The mean time to metastasis was fifty months. Four patients were clinically disease-free at a mean follow-up of 94.5 months, while five patients died as a result of progressive local or metastatic disease at a mean follow-up of 31.4 months. Only one patient had normal bowel and bladder control postoperatively, and only three were able to walk without assistive devices. Eight patients had wound complications, and one patient had a deep-vein thrombosis. With the numbers available, neither negative margins at the time of initial tumor resection nor adjuvant radiation therapy had a significant impact on survival or local recurrence. More cephalad levels of resection were associated with significantly worse bowel (p = 0.01) and bladder (p = 0.01) control. Complications were frequent and were more common with a larger tumor size at the time of presentation (p = 0.034). CONCLUSIONS: The treatment of sacral chordoma is an arduous clinical undertaking that requires a multidisciplinary approach and attention to detail from the outset. Despite aggressive well-planned surgical management and adherence to strict surveillance protocols, frequent recurrence and the late onset of metastatic disease are to be expected in a substantial proportion of patients, especially those with a very large chordoma or one at a more cephalad level. Adequate surgical treatment results in substantial functional impairment and numerous complications; however, it does offer the possibility of long-term disease-free survival. We advocate an attempt at complete resection, when there is still a possibility of cure, and aggressive treatment of local recurrences. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2006

Transplantation of osteochondral allografts after cold storage.

BACKGROUND: Transplantation of fresh osteochondral allografts stored at hypothermia into knee cartilage defects is a common procedure; however, the length of time that allografts can be stored prior to transplantation is controversial and has been determined, in part, by the results of vital stain uptake by chondrocytes. This study was performed to further define the limits of allograft storage. METHODS: Articular cartilage from six cadavers was stored for up to fifty-one days in tissue-culture media, and histologic sections were evaluated histomorphometrically to quantify the loss of chondrocytes. Samples of the cartilage were also placed into tissue culture to assess cell growth. Animal studies were performed in parallel on sixteen adult baboons with osteochondral allografts transplanted into the medial femoral condyle. Prior to transplantation, all allografts were stored in RPMI-1640 with 10% fetal calf serum at 4 degrees to 6 degrees C for up to eighty-five days. The transplants were graded on their gross and histological appearance, as well as their histochemical properties. RESULTS: Many of the human samples stored at hypothermia in culture media for up to forty days retained some recognizable chondrocytes, but morphometry showed a gradual, significant decrease in the number of chondrocytes after nine days (p = 0.001). In addition, the cell outgrowth occurred from all specimens stored for up to fifteen days but not in samples stored for longer than thirty-four days. In animal studies, transplanted allograft cartilage that had been stored for less than eighteen days looked smooth and glistening, but grafts stored for over twenty-one days were pale, pitted, fragmented, or yellow, and chondrocytes were absent. CONCLUSIONS: Time-dependent loss of chondrocytes in articular cartilage stored at hypothermia, especially in specimens stored for longer than fifteen to twenty days, was observed in this study. Cartilage allografts transplanted into nonhuman primates after twenty-one days of storage underwent more severe degenerative changes than allografts that had been stored for less than twenty-one days. These findings suggest caution when transplanting cartilage stored at hypothermia for over twenty days.

Adult↗
PubMed2005

Ganglioneuromas of the sacrum-a report of two cases with radiologic-pathologic correlation.

Ganglioneuromas are rare, benign, well-differentiated, slow-growing tumors, composed of ganglion cells and Schwann cells. Ganglioneuromas are derived from the neural crest cells and can arise anywhere from the base of the skull to the pelvis. We present and discuss the clinicopathologic and radiographic features of two patients with ganglioneuroma arising from the sacrum, a rare anatomic location.

Adult↗
PubMed2005

Dysplasia epiphysealis hemimelica of the tibial tubercle.

Dysplasia epiphysealis hemimelica (DEH) is a rare skeletal dysplasia with epiphyseal involvement first described by Mouchet and Belot in 1926. Lower extremity involvement is common and might involve a single or multiple epiphyses in the affected extremity. We report an unusual case of involvement of the tibial tubercle in a girl aged 4 years 8 months, and we present the clinical, radiographic and pathologic findings. We discuss the role of MRI in the diagnosis and treatment plan.

Child, Preschool↗
PubMed2005

Rosai-Dorfman disease presenting as multiple soft tissue masses.

Rosai-Dorfman disease is a rare clinical disorder which may present in many forms. While classically a disease of lymph nodes, soft tissue involvement is fairly common. Soft tissue involvement can occur without any lymphatic or systemic involvement, and may be difficult to diagnose. We describe a patient presenting with multiple soft tissue masses which on biopsy proved to be isolated cutaneous Rosai-Dorfman disease. MR imaging showed two well-defined nonspecific superficial masses that enhanced intensely. Review of the literature suggests that when this disease presents in soft tissue, multiple foci of involvement may be common. Although rare, Rosai-Dorfman disease should be considered in the differential diagnosis of patients presenting with multiple soft tissue masses.

Adult↗
PubMed2005

The causes of pain in benign solitary enchondromas of the proximal humerus.

Patients with benign solitary enchondromas of the proximal humerus frequently present to the diagnosing physician with shoulder pain. Once the lesion is considered benign, emphasis can be placed on identifying the etiology for the pain. We reviewed our experience with these patients to identify the cause of the presenting pain. A retrospective review of clinical records and radiographic studies (radiographs, magnetic resonance images, and bone scans) was done for all patients presenting to an orthopaedic oncology unit with solitary enchondroma of the proximal humerus. Attention was focused on diagnostic evidence of additional disease in the shoulder. Fifty-seven patients (mean age, 53.6 years) met the criteria of the study and were included for evaluation. Of patients presenting with pain, 82% (47 of 57 patients) had findings seen on magnetic resonance imaging scans that correlated with the initial clinical diagnostic impression, suggesting that other disease was present that could explain the pain. Solitary enchondromas of the proximal humerus often are found incidentally during the initial evaluation of patients with shoulder pain. This study showed that additional treatable disease usually is present in patients with enchondromas of the proximal humerus.

Acromioclavicular Joint↗