Biomedical subjects
Publications and source records attributed to M M Lewis.
A familiarity with the characteristics and behavior of musculoskeletal neoplasms will allow for the delivery of timely and appropriate treatment. In this article the significance of historical and clinical data is discussed in general terms, followed by a rationale for office-based evaluation of these lesions. Some of the more common lesions are then discussed in greater detail.
A 34-year-old man developed a spindle-cell sarcoma originating in a preexisting lesion of monostotic fibrous dysplasia. A review of the literature reveals 83 cases of a malignant degeneration in fibrous dysplasia; osteosarcoma was the most common type of tumor. The next most common were fibrosarcoma and chondrosarcoma. The malignant tumor usually developed in the third or fourth decade of life. The most frequent anatomic sites were the craniofacial bones, the femur, and the tibia. Twenty-three of the 83 cases were treated with local radiation. In fibrous dysplasia, any abrupt alteration in the clinical course, manifested by pain and swelling, raises the possibility of malignant degeneration.
Subperiosteal hemangioma (SPH), an exceptionally rare lesion, was diagnosed in a 68-year-old man. SPH is usually small and is most commonly located in the midshaft of a long tubular bone such as the tibia or fibula. A wide range of age groups is affected. SPH may present with mild pain or local swelling unassociated with trauma. Radiologically, it usually appears as a shallow cup-shaped depression surrounded by cortical thickening. Several other periosteal and intracortical lesions must be considered in the differential diagnosis, but the final diagnosis rests on microscopic evaluation. The treatment of SPH is marginal excision; local recurrences have not been reported after such treatment.
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The first reported case of a periosteal ganglion to be documented by computerized tomography is presented. The lesion was located on the shaft of the tibia and was unrelated to ligamentous and joint structures. A review of the literature reveals that the most common site for this lesion is the upper leg, as noted in our case; for that reason, periosteal ganglion should be included in the differential diagnosis of any soft tissue lesion in this location. CT may be more useful than plain films to demonstrate periosteal ganglion when cortical erosion is absent.
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Limb-sparing surgery for malignant bone tumors in the growing child usually has been avoided because of anticipated limb-length discrepancy, especially in the lower extremity. Therefore, amputation or modified amputation was often the treatment of choice. The purpose of this article is to introduce a new concept: an expandable and adjustable internal prosthesis that can be used in the growing child in the properly selected patient after removal of the malignant neoplasm. This procedure is an alternative to amputation.
In recent years the orthopaedist has become the initial physician to see soft tissue neoplasms. A review of the current concepts of treatment of these lesions, therefore, seems to be in order.
A case report of clear cell sarcoma of the tendinous portion of the quadriceps in the knee joint of a 33-year-old female is presented. This insidious, usually painless malignant tumor is often misdiagnosed and may be referred to the sports medicine specialist as a sport-related injury. The duration of symptoms and the size of the lesion are important prognostic factors. Wide excision or radical surgery is necessary to cure such tumors. With improved reconstructive techniques, including free vascularized myocutaneous flaps, limb-sparing surgery is now possible.
Forearm position matching tasks were performed by blindfolded subjects before and after applying vibration for 60 s to the biceps or triceps muscle of one arm. Following cessation of vibration, statistically significant alignment (proprioceptive) errors occurred when a movement lengthened the previously vibrated muscle. The error was such that the length of the post-vibrated muscle was greater than the length of the same muscle in the non-vibrated arm. This effect is the opposite to that which occurs during vibration.
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Two cases are presented in which allograft reconstruction followed wide resection of recurrent, aggressive aneurysmal bone cysts of the distal fibula. The authors find that allograft implantation provides a safe and effective method of reconstruction.