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Biomedical subjects

J Mirra

Publications and source records attributed to J Mirra.

At least 19 recordsLinked to original sources
PubMed2001

Osteolysis in a cementless, second generation metal-on-metal hip replacement.

A 65-year-old man with osteoarthritis of the hip underwent a cementless total hip replacement with a modern generation, metal-on-metal bearing. Two years later the patient presented with localized osteolysis at the tip of the femoral stem. At the time of revision, the stem was found to be well-fixed. Extensive analyses of the bearing surfaces and periprosthetic tissues were done. There was minimal bearing surface wear and only small numbers of inflammatory cells, such as macrophages, in the tissues, and it was concluded that this was not a typical case of particle-induced osteolysis. All cultures and laboratory studies were negative for infection. This case report supports the multifactorial nature of osteolysis, which includes the osteolytic potential of joint fluid access to and fluid pressures within, the effective joint space.

Aged↗
PubMed2000

Viability of femoral heads treated with resurfacing arthroplasty.

There is a general conception that resurfacing arthroplasty causes femoral head osteonecrosis and subsequent failure of the implant. This study histologically analyzed 25 resurfaced femoral heads up to 12 years postoperatively and found that osteonecrosis was not induced by the procedure.

Arthroplasty, Replacement, Hip↗
PubMed1999

Expression of tau proteins and tubulin in extraskeletal myxoid chondrosarcoma, chordoma, and other chondroid tumors.

Tau proteins are microtubule-associated proteins required for the polymerization of tubulin. The abnormal accumulation of tau proteins in neurofibrillary tangles is a well-known phenomenon and has been studied extensively. However, the role of tau protein in chondroid tissue and its neoplasia is unknown. In the present study, 2 extraskeletal myxoid chondrosarcomas (EMCs), 6 chordomas, 6 chondrosarcomas, 3 myxoid chondrosarcomas of bone, 2 osteochondromas, 6 chondroblastomas, and 2 nonneoplastic adult articular cartilages were immunostained with monoclonal antibodies against tau proteins and tubulin. The results showed that the coexpression of tau proteins and tubulin was present only in EMCs (2/2) and chordomas (4/6). Although tubulin was detected in chondroblastomas (5/6), osteochondromas (2/2), chondrosarcomas (5/6), and myxoid-chondrosarcomas of bone (3/3), tau expression was absent in these tumors. The perichondrial chondroblasts but not chondrocytes from nonneoplastic articular cartilage also localize tau and tubulin with a much weaker staining intensity. The results mainly demonstrate that there is frequent expression of tau proteins in some microtubule-rich neoplasms, such as EMC and chordoma. The different immunostaining pattern of tau proteins between chordoma and myxoid chondrosarcoma of bone may be useful in the differential diagnosis, especially when both neoplasms occur in the base of skull.

Adult↗
PubMed1997

Fibrous cortical defect with bizarre nuclear features.

A femoral neck fibrous cortical defect with typical radiographic features had bizarre nuclear features on histological examination. Recognition of the benign radiographic appearance, similar bizarre features of accompanying macrophages, and paucity of mitoses led us to consider this a pseudoanaplastic ischemic or degenerative change in an old fibrous cortical defect. Because the biological behavior was not known with certainty, we closely followed this case. After 25 months, there has been no recurrence or regrowth. The close cooperation between the pathologist and other disciplines facilitates recognition of these pseudoanaplastic lesions and development of treatment strategies for lesions of unknown or uncertain biological behavior.

Adult↗
PubMed1997

Miliary osteosarcomatosis with associated hypocalcemia.

We report the case of a patient with a rare miliary variant of osteosarcoma associated with symptomatic hypocalcemia and review the literature regarding the pathogenesis of multifocal osteosarcoma, treatment options, and the associated hypocalcemia.

Adult↗
PubMed1993

Thallium-201 scanning for the evaluation of osteosarcoma and soft-tissue sarcoma. A study of the evaluation and predictability of the histological response to chemotherapy.

We evaluated sequential thallium scans, made before and after a period of preoperative chemotherapy, for sixteen patients who had a high-grade sarcoma of bone or soft tissue. The purpose was to determine whether this technique could be used to ascertain accurately the amount of viable tumor as well as to predict the response to chemotherapy. Nine of the ten patients who had a reduced thallium uptake after chemotherapy also had a marked histological response, with necrosis of the tumor of at least 95 per cent. Six patients were seen to have no improvement on the thallium scans, and this finding correlated with necrosis of the tumor of less than 95 per cent. Thallium chloride has been shown to have an affinity for a variety of osteosarcomas and soft-tissue sarcomas. The mechanism of intracellular uptake is one of active transport, which makes thallium chloride a more accurate barometer of the viability of the tumor cells and of metabolic activity than scanning agents that are flow-dependent. We believe that sequential thallium scintigraphy should be used in conjunction with other imaging modalities in the diagnosis, planning of treatment, and follow-up evaluation of patients who have a sarcoma of bone or soft tissue. This technique appears to be useful in the prediction of the histological response of high-grade osteosarcomas and soft-tissue sarcomas to preoperative chemotherapy.

Adolescent↗
PubMed1993

Osteoid osteoma diagnosis and management with low morbidity.

Wide excision, a recommended treatment for osteoid osteoma, creates needless resection of surrounding bone and causes difficult intraoperative nidus identification. Less bone resection is required by successively burring through the reactive bone to identify the nidus, which is then removed with curettes and burrs. This burr-down technique requires precise preoperative anatomic localization by thin section (1-1.5 mm) computed tomography (CT) scans. In a consecutive series of 19 osteoid osteomas, 18 were accurately diagnosed before operation, using a combination of clinical findings, plain roentgenograms, and CT scans. The burr-down technique was successfully used in 15 cases, and four were treated with wide excision. There have been no local recurrences. The follow-up period for all 19 patients was at least six months. No bone grafts were required in the burr-down group in nonspinal locations; there have been no fractures despite early return to unrestricted activity. The burr-down technique was associated with less postoperative immobilization, a shorter duration of protected weight bearing, and an earlier return to activity. The burr-down technique is recommended for accessible osteoid osteoma lesions.

Adolescent↗
PubMed1990

Progress in the recognition and treatment of soft tissue sarcomas.

Over the past 10 years there has been significant progress made in the recognition and treatment of soft tissue sarcomas. With the advent of CAT scans and MRI, preoperative delineation of soft tissue tumors has become readily available. The diagnostic use of these modalities in patients presenting with an ill-defined asymptomatic mass has been extremely helpful in terms of screening patients to decide whether or not a biopsy is indicated. These techniques have also provided a much clearer delineation of the anatomic extent of the primary tumor, which has been of great assistance both in radiation therapy treatment calculations as well as in preoperative surgical planning. The recognition that tumor grade is the dominant prognostic variable has resulted in the more common use of a grading system, and a more uniform reporting and stratification of end results. Recent studies with immunohistochemical staining have proven of value in determining the histogenesis of many tumors that in the past were difficult to classify accurately. Most recently the use of flow cytometry suggests that this will also be a valuable adjunct in determining tumor grade and thereby prognosis. The most recent investigations of molecular biologic evaluation of genetic DNA and RNA sequences, as well as of oncogenes are extremely interesting from a diagnostic standpoint and in demonstrating the potential of molecular biologic evaluation for understanding the origin of these tumors. Multimodality therapy with surgery, radiation, chemotherapy, or all three has resulted in a marked improvement in local tumor control for patients with soft tissue sarcomas. The combination of modalities has allowed smaller surgical excisions of the tumor and thereby preservation of the extremity and much of its function. There are currently several different methods of multimodality therapy used including neoadjuvant therapy and postoperative therapy, both of which have been proven efficacious. Chemotherapy is now playing an increased role in clinical investigation and treatment. The availability of Adriamycin, DTIC, cisplatin, and most recently ifosfamide has added several chemotherapeutic agents for use by the clinician. Combination chemotherapy and radiation is of value in the neoadjuvant setting, and several studies are now underway to determine whether postoperative adjuvant chemotherapy is of similar value in reducing systemic spread of disease. Finally, surgical resection of pulmonary metastases has been proven of value in 20% to 25% of patients who subsequently develop metastatic disease. As a result of these advances in several different treatment disciplines, the overall survival rate and quality of life of patients with soft tissue sarcoma have improved markedly over the past 10 years.(ABSTRACT TRUNCATED AT 400 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Thallium-201 scintigraphy in bone sarcoma: comparison with gallium-67 and technetium-MDP in the evaluation of chemotherapeutic response.

This study attempts to characterize thallium-201 (201TI) uptake in patients with bone and soft-tissue sarcoma and to compare these findings with gallium-67 (67Ga) and bone scintigraphy with emphasis on evaluating tumor viability before and after chemotherapy. Thirty-eight patients with surgically-proven sarcomas were evaluated. All patients had gallium and thallium studies. Nineteen patients underwent pre- and post-chemotherapy thallium and evaluation. Seven patients also had technetium-99m-MDP (99mTc-MDP) bone scintigraphy comparisons. Pathologic changes pre- and postchemotherapy were graded on the basis of %tumor necrosis as defined histologically. Scintigraphic comparisons demonstrated a high degree of correlation with 201TI and poor correlation with 99mTc-MDP. Thallium-201 was superior to 99mTc-MDP and 67Ga in predicting tumor response to chemotherapy as determined by %tumor necrosis determined histologically. Gallium was superior to Tc-MDP in predicting response to chemotherapy. However, both 67Ga and 99mTc-MDP appear to be affected by factors other than tumor activity.

Adolescent↗
PubMed1988

Results of core decompression for femoral head osteonecrosis.

The progression of femoral head osteonecrosis (FHON) culminates in destruction of the hip joint, a devastating consequence for young people who are predominantly affected. Core decompression, as a means of ameliorating the disease, was evaluated in 45 hips in 33 patients with nontraumatic FHON. The mean clinical and roentgenographic follow-up period was three years (range, 1-7 years). None of the ten Ficat Stage I hips progressed, 11 of 26 Stage II hips progressed, and five of nine Stage III hips progressed to coxarthrosis. In those hips in which there was an association with steroid therapy, there was 50% progression when steroids were continued, compared with 22% progression when steroids had been discontinued. Core decompression is prescribed for Ficat Stage I and II. Patients on continuous post-operative treatment with steroids for associated conditions should be advised of the high risk of progression.

Adult↗
PubMed1988

The use of MRI to assist in diagnosis of pigmented villonodular synovitis of the knee joint.

Pigmented villonodular synovitis (PVNS) of the knee joint remains a difficult and elusive entity to define and characterize. This entity most often appears in the young adult knee with nonspecific clinical features, including a painful range of motion and perhaps a sensation of locking. Detection and diagnosis of this localized soft-tissue mass are difficult because plain roentgenograms may be totally within normal limits. The case of a 21-year-old woman illustrates the use of magnetic resonance imaging (MRI) as an effective technique to define and characterize PVNS. Advantages of MRI include high-resolution/high-contrast multiplanar sections that depict bone, marrow, ligaments and tendons, fat, menisci, and articular cartilage in one image. In addition, MRI is noninvasive and requires no ionized radiation. MRI is an excellent clinical tool for the evaluation of intraarticular tumors of the knee joint.

Adult↗
PubMed1984

Alveolar soft part sarcoma following radiotherapy for a spinal hemangioma. A case report.

A case of alveolar soft part sarcoma arising some 20 years later in a site previously irradiated as a treatment for a spinal cord hemangioma is described. This is the first known case of radiation-associated alveolar soft part sarcoma, and it fulfills the criteria for a tumor to be radiation-induced. The coincidental finding of "viral-like" particles within some of the tumor cells was noted.

Head and Neck Neoplasms↗
PubMed1984

Parasymphyseal insufficiency fractures of the os pubis.

Twelve parasymphyseal insufficiency fractures of the os pubis are described in eight osteopenic postmenopausal women, three of whom had rheumatoid arthritis. The fractures involved both right and left pubic bones in three women. Radiographically lesions often appear deceptively destructive and malignant. In six patients, biopsy was performed and showed no tumor. Biopsy can be avoided in an osteopenic woman with recent increased activity, pubic pain, and the characteristic pubic lesion.

Aged↗
PubMed1983

Intranuclear branched cylindrical structures in human osteosarcoma cells.

A peculiar branched cylindrical structure within the nuclei of human osteosarcoma cells is reported. Although the described structures may be postulated to represent either "vermicellar bodies" or a response to cellular injury by chemotherapeutic agents, their origin and function are unknown to us.

Adult↗