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Biomedical subjects

J H Healey

Publications and source records attributed to J H Healey.

125 records · Page 7Linked to original sources
PubMed1987

Lactase dehydrogenase as a tumor marker for recurrent disease in Ewing's sarcoma.

The serum lactase dehydrogenase (LDH) of 56 patients with Ewing's sarcoma was examined to determine the use of LDH as a tumor marker. The initial LDH level was used to determine its ability to predict survival. The follow-up LDH level also was examined, as an indicator of recurrent disease. The initial LDH level was found to have no prognostic value. Both patients with elevated and normal LDH levels had the same survival rate. The LDH level at recurrence was significantly higher, however, than the follow-up LDH level of those without recurrence (P less than 0.001). The LDH level was most sensitive as a tumor marker for recurrent disease in those patients with multiple sites of tumor involvement at the time of recurrence.

Bone Neoplasms↗
PubMed1987

Osteoporosis: the structural and reparative consequences for the skeleton.

We have discussed the biomechanical and biomaterial properties of bone with emphasis on the microenvironment. The microdensity of bone tissues determines the resistance to compressive forces (strength = density2). The structural orientation of bone determines the ability of bone to withstand torsion and bending forces. Highly remodeled bone is brittle and fractures easily because of the multiple reversal planes within the bone plates. Conversely, augmentation of bone on the periphery by modeling leads to increased material microstrength and structural macrostrength. Consequently, appositional modeling augments whereas remodeling diminishes bone strength. Hip fractures, spinal fractures, Colles' fractures, and pelvic fractures have been discussed in terms of their pathophysiology and treatment. An algorithm (Fig. 4-7) has been presented for the differential diagnosis of patients with recently discovered spinal compression fractures. Lastly, a discussion of exercise demonstrated its beneficial role, especially in the retention of bone mass.

Biomechanical Phenomena↗
PubMed1987

Modification of the skin incision for the Van Nes limb rotationplasty.

The survival of patients with bone sarcomas has improved dramatically with the advent of modern chemotherapeutic regimens, fostering a present trend toward limb sparing procedures. In skeletally immature patients, prosthetic replacement of resected bones and joints is unrealistic because of continued expected growth in the limbs. A stump-lengthening procedure, the reduction-rotation-plasty, has become a valuable alternative to high above-knee amputation. A rhombus-shaped skin incision around the thigh and calf, originally described by Kotz and Salzer, led to a significant discrepancy of the circumference of the proximal and distal skin borders. A circumferential skin incision at the midthigh and a fishmouth-shaped incision at the upper calf was designed to decrease this disproportion. This incision has been used in five consecutive patients with osteosarcoma about the knee. The cosmetic results were excellent, prosthetic fittings were facilitated, and neither vascular nor wound healing problems were encountered.

Artificial Limbs↗
PubMed1986

Acrometastases. A study of twenty-nine patients with osseous involvement of the hands and feet.

We studied the records of twenty-nine patients with forty-one metastatic lesions of the hand or foot. In five patients the lesions mimicked a benign condition, and inappropriate treatment was given. In eleven patients the acrometastases were the first indication of malignant disease, and four other patients had no known primary malignant lesion. Amputation of a phalanx, digit, or ray is recommended for most solitary phalangeal, metacarpal, or metatarsal lesions when the expected period of survival of the patient exceeds a few months.

Adolescent↗
PubMed1986

Chondrosarcoma.

Chondrosarcoma is a malignant cartilage-forming tumor that affects predominently the middle-aged population. There are three histologic grades, but differentiation of Grade I tumors from enchondromas can be difficult. The measurement of polypoidy (augmented chromosomal content per cell) appears to offer a method of segregation of benign from low-grade from high-grade tumors. With the exception of the high-grade spindle elements, current chemotherapy does not appear to affect chondrosarcomas. Retinoic acid, however, by enhancing lysosomal enzyme release, may be a potential efficacious therapeutic agent. Enhanced tumor staging as provided by the computed tomographic (CT) scan has demonstrated the boundaries for wide surgical excisions, most notably internal hemipelvectomies for low- and moderate-grade pelvic chondrosarcomas. Currently, low-grade chondrosarcomas have an overall five-year survival of 65%--85% in contradistinction to 15% for the highest grade chondrosarcomas.

Adult↗
PubMed1986

Osteoid osteoma and osteoblastoma. Current concepts and recent advances.

Osteoid osteomas are common lesions, constituting one-eighth of the benign bone tumors. Their size (less than 1.5 cm) and characteristic radiographic and clinical presentation are usually diagnostic. Response to salicylates is quite variable and not a reliable sign. Extremely high levels of prostaglandin metabolites have been found in osteoid osteomas and may explain the inflammatory features of the lesions. Preoperative localization with computed tomography (CT) scans and intraoperative confirmation of location and resection with radioscintigraphy have dramatically reduced the recurrence rate in the last 26 patients. Complete excision, even if accomplished by intralesional technique, is successful in eradicating the tumor. Osteoblastomas constitute 1% of bone tumors. Although their histology differs minimally from osteoid osteomas, they achieve a larger size and behave more aggressively. Commonly occurring in the spine, they require careful anatomic delineation with CT scans and myelography. Complete excision eliminates the lesion.

Adolescent↗
PubMed1985

Solid leukemic tumor. An uncommon presentation of a common disease.

Granulocytic sarcoma of the clavicle occurred in a 17-year-old boy. The patient had a densely sclerotic bony lesion with periosteal reaction and no peripheral blood manifestations of leukemia. Supraclavicular adenopathy developed after a preliminary diagnosis of Ewing's sarcoma was made, and a second biopsy was performed. Electron microscopy of the tissue showed Auer bodies and Charcot-Leyden granules characteristic of acute myelogenous leukemia. Combination chemotherapy, local irradiation, and clavicular resection have left the patient with no evidence of disease 50 months after diagnosis. Leukemia may appear as a solitary bone tumor before hematologic changes develop. Granulocytic sarcomas can have the radiographic and histologic appearance of primary bone tumors. Bone marrow examination and electron microscopy of biopsy tissue are diagnostic of leukemia and are important in all hospital investigations of round-cell tumors of bone.

Adolescent↗
PubMed1985

Structural scoliosis in osteoporotic women.

Fifty women (mean age 69 +/- 5 years) with biopsy-proven osteoporosis and back pain were radiographically studied for scoliosis, kyphosis, and compression fractures. Twenty-four (48%) osteoporotics had at least 10 degrees of structural scoliosis. Curves were indistinguishable from those of idiopathic scoliosis. Lumbar and thoracolumbar curves were most common. The kyphosis averaged 70 degrees +/- 17 degrees and spanned 9.8 +/- 1.75 vertebrae. Forty-seven patients had 140 compression fractures. Fractures occurred within, but were usually not the cause of, scoliotic curves. Scoliosis in elderly women is a clinical marker and may be a risk factor for osteoporosis and compression fractures. Adult scoliotic patients should be evaluated for osteoporosis with iliac bone biopsies and aggressively treated.

Aged↗
PubMed1985

Creatine kinase MB in skeletal muscle and serum of spine-fusion patients.

The low specificity of creatine kinase (CK) MB elevations for myocardial infarction was confirmed by a prospective analysis of paraspinal muscle and postoperative serum levels of CK-MB. Eleven of 30 patients had serum elevations of CK-MB without myocardial infarction. Elevated CK-MB was not specific for myocardial infarction after spine surgery. CK-MB was found in paraspinal muscle of 93% of patients. CK-MB may be a pathologic marker in patients with spinal disease.

Adolescent↗
PubMed1985

The coexistence and characteristics of osteoarthritis and osteoporosis.

We defined the clinical features and radiographic coexistence of osteoarthritis and osteoporosis in fifty women with primary coxarthrosis and fifty age-matched women (average age, 69 +/- 5 years) with idiopathic osteoporosis. The patients with osteoarthritis had undergone total hip replacement. The diagnosis of primary osteoarthritis was established by clinical, radiographic, and histological criteria, and the diagnosis of osteoporosis was confirmed by histomorphometric analysis of specimens taken at iliac-bone biopsy. In the arthritic patients, spinal osteoporosis was identified by radiographic evidence of compression fractures, kyphosis, and scoliosis. Femoral osteoporosis was demonstrated by the index of Singh et al. and the femoral canal-shaft ratio. In the osteoporotic patients coxarthrosis was measured radiographically by the scale of Kellgren and Lawrence. On the average, the osteoporotic patients were twelve kilograms lighter than the osteoarthritic patients. Fifty-eight per cent of the osteoporotic and 18 per cent of the osteoarthritic patients had a scoliotic curve of at least 10 degrees. The prevalence of osteoarthritis of the hip in the osteoporotic women was 4 per cent, and the prevalence of compression fractures in the arthritic women was 6 per cent, which was approximately one-quarter of the expected incidence. These results show that: (1) osteoporosis does not protect against the development of coxarthrosis, (2) coxarthrosis is a negative risk factor for osteoporotic compression fractures, and (3) scoliosis and an ectomorphic habitus are clinical markers that identify a risk for osteoporosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Quality of life as defined by orthopedic oncology patients.

BACKGROUND: Quality of life (QOL), not just survival, is central to outcomes analysis in musculoskeletal oncology. However, little information exists about the patients' definition of what constitutes QOL. METHODS: Self-administered outcomes questionnaires were given to 201 surgically treated patients with lower extremity tumors. Of these patients, 192 (137 with malignant tumors, 55 with benign tumors) provided a written definition of QOL. Their responses were independently collated and matched with clinical information. RESULTS: For most patients (153, or 80%) the definition of QOL encompassed several attributes. A consistent combination of four major attributes was used in the QOL definition by 44 (32%) of the malignant cases and 19 (35%) of the benign cases. Differences in responses between men and women were idiosyncratic and more common in the benign group. Good family relations and good health were equally important to men and women. Responses varied by patient age. Older patients valued self-sufficiency and freedom from pain, whereas younger patients emphasized happiness, trust in God or church, achieving goals and being successful, and love. Those whose surgery was less extensive cited good family relations, the ability to function physically and emotionally, and having a good job or work. CONCLUSION: The variation in patients' perspectives and definitions of quality of life must be taken into account when assessing QOL in musculoskeletal oncology patients. Patients often emphasize concerns that are not adequately addressed by current outcomes-measures in orthopedics and general oncology.

Adolescent↗
PubMedDate not supplied

Multicentric osteosarcoma, Rothmund-Thomson syndrome, and secondary nasopharyngeal non-Hodgkin's lymphoma: a case report and review of the literature.

PURPOSE: Rothmund-Thomson syndrome (RTS) is an autosomal recessive disease characterized by poikiloderma, photosensitivity, skeletal deformities, and other changes. It is also associated with an increased risk of malignancies, including osteosarcoma. Sixteen previous cases of RTS and osteosarcoma have been reported. PATIENT: A patient with RTS in whom multicentric osteosarcoma developed is described. After surgery and chemotherapy, a secondary malignant neoplasm (SMN) developed consistent with nasopharyngeal non-Hodgkin's lymphoma. RESULTS: The patient was treated with anti-CD20 monoclonal antibody and is in complete remission. CONCLUSION: This is the first report of a patient with RTS treated for osteosarcoma in whom a SMN developed. Potential factors involved in this SMN include genetic predisposition and previous chemotherapy.

Adult↗
PubMedDate not supplied

Resection of the sciatic, peroneal, or tibial nerves: assessment of functional status.

BACKGROUND: Lower-extremity tumors are often treated by amputation rather than limb-sparing excision that sacrifices the sciatic nerve or a branch. This study assessed the functional outcome of major nerve sacrifice during limb-sparing resections for lower-extremity soft tissue sarcoma. METHODS: Patients who underwent division of the sciatic, tibial, or peroneal nerve(s) during limb-sparing sarcoma surgery (January 1982 through June 2000) were identified. Eleven surviving patients evaluated their pre- and postoperative functional status by self-administered questionnaire (six sciatic, two tibial, and three peroneal nerve divisions). RESULTS: Eighteen patients (10 male, 8 female; 14-84 years old) had nine primary and nine locally recurrent tumors. Tumors were high (16) or low grade (two). Five patients died of disease and two died of other causes. Median overall survival was 50 months. One of 11 reported increased pain. Eight had new phantom sensations with a median intensity of 4.5 (1 = least; 10 = most). All patients used an ankle brace to walk after a sciatic (four) or peroneal (one) division. Walking ability and distance after surgery was unchanged (nine), improved (one), and worsened (one). Standing improved in 7 of 11 patients. Proprioception in the affected extremity was retained in six. The median postoperative leg functional score was 8 (1 = worst; 10 = best). No patient developed foot ulcers. One patient underwent amputation for recurrence. All patients preferred their status over having an amputation. CONCLUSIONS: Objectively and subjectively, division of the major lower-extremity nerves causes acceptable functional deficits in most patients. Resection of affected sciatic nerve (branches) during limb-sparing tumor surgery is an excellent alternative to amputation.

Adolescent↗
PubMedDate not supplied

Cartilage tumors: evaluation and treatment.

The proper treatment of cartilaginous tumors is dependent on the clinicopathologic and radiologic findings. Enchondroma is a benign tumor that is usually asymptomatic and thus should be treated nonoperatively. Symptomatic enchondromas are often treated by intralesional excision. Intramedullary low-grade chondrosarcoma is a malignant tumor that is usually painful. The treatment of low-grade chondrosarcoma may range from intralesional excision with or without adjuvant therapy to wide excision. Although intralesional excisions have a higher bone and joint preservation rate than wide excisions, they may be associated with a higher local recurrence rate. Intermediate- and high-grade chondrosarcomas are treated with wide excisions. The treatment of these cartilaginous lesions should involve a multidisciplinary team including a musculoskeletal surgeon, a radiologist, and a pathologist.

Bone Neoplasms↗