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Biomedical subjects

R C Marcove

Publications and source records attributed to R C Marcove.

At least 37 records · Page 2Linked to original sources
PubMed1988

Massive solitary tophus containing calcium pyrophosphate dihydrate crystals at the acromioclavicular joint.

A massive solitary tophus containing calcium pyrophosphate dihydrate (CPPD) crystals was resected from the distal clavicle and proximal acromion of a 62-year-old man who presented with a painful shoulder mass. The diagnosis was confirmed histologically and by X-ray diffraction. CPPD crystal deposition was found within bone, however, the articular cartilage was not involved. Other unusual features of the case include the size of the lesion, the monoarticular presentation and a peculiar discoloration of the overlying skin. The clinical presentation and radiographic features were initially consistent with a malignant process; thus the case demonstrates that CPPD arthropathy should be included in the differential diagnosis of periarticular tumors.

Acromioclavicular Joint↗
PubMed1988

Pseudoaneurysm of the popliteal artery with an unusual arteriographic presentation. A case report.

Pseudoaneurysms caused by osteochondromas during the second decade of life are well known. Arteriography is generally helpful in the diagnosis of a false aneurysm. In a 30-year-old man, the case was unique in that the arteriogram failed to show the aneurysm at all. Physical examination revealed yellow discoloration and tiny hemangiomas of the skin over the fossa poplitea. More emphasis should be placed on the physical examination and less on the arteriogram in making a correct diagnosis.

Adult↗
PubMed1987

Sacrococcygeal chordoma. A clinicoradiological study of 60 patients.

Sixty patients with sacrococcygeal chordoma, who were seen at this center between 1946 and 1985, were studied with particular attention to the radiographic findings. This study was undertaken because of the large number of these cases and comparison was made between the plain films available in 39 patients and the computed tomography CT studies in 22. Bone destruction was found in 78% on plain films but in 90% on CT. A soft tissue mass was identified in plain films in 60% but in 90% on CT. Calcific debris was found in plain films in 44% but in 87% on CT. Mostly the debris consisted of coarse irregular fragments and probably represented sequestrated necrotic bone. Myelography was performed in only 15 patients. Angiography was studied in 10 cases. Of the 60 patients 88% underwent surgical resection. The tumor recurred in 80% and in only 20% was there no evidence of recurrence. Distant metastases occurred in 24% of patients. Fifty percent survived 5 years; 28% survived 10 years; mean survival 7.5 years.

Adult↗
PubMed1987

Chondrosarcoma in the young. A clinicopathologic analysis of 79 patients younger than 21 years of age.

We have studied 79 patients with chondrosarcoma who were younger than 21 years of age; this number represents 16% of all patients with chondrosarcoma diagnosed and treated in this hospital during half a century. The appendicular skeleton (53%), the humerus (13%), and the femur (23%) were most frequently affected. The pelvic bones were also common locations (20%). Pain, the presence of a mass, and tenderness were the most common presenting complaints. Two-thirds of the sarcomas were central lesions; the rest were mostly of the peripheral type. In 22 patients (28%), the chondrosarcomas were secondary to pre-existing benign solitary or multiple cartilaginous lesions. Histologically, the chondrosarcomas were subdivided into conventional, myxoid, "mesenchymal," and spindle cell (dedifferentiated) variants. Microscopically, the chondrosarcomas were graded according to their increasing grade of malignancy (grade I: 24 patients; grade II: 23 patients; grade III: 32 patients). Detailed survival analysis was performed and survival comparisons were made between the various age groups, the time of treatment, the sex of the patients, various skeletal sites, and the histologic grade of malignancy of the chondrosarcoma. It appears that chondrosarcoma affecting younger individuals is, in general, a more ominous tumor as compared with adults; i.e., relatively more high-grade chondrosarcomas affect young people than adults. Another notable difference was the dissimilarity in the skeletal distribution pattern of the malignant cartilage lesions between adults and the young.

Adolescent↗
PubMed1985

Effect of intensive adjuvant chemotherapy on wound healing in 69 patients with osteogenic sarcomas of the lower extremities.

Reported surgical adjuvant trials in humans have resulted in little clinically significant impairment of wound healing. Such trials are often carried out with subtherapeutic doses or with the drugs administered relatively late in the wound healing process. It is the objective of our study to investigate the effect of intensive pre- and postoperative chemotherapy (BCD, ADR, HD-MTX) on wound healing in patients with osteogenic sarcomas. Wound healing was defined in our study as lack of infection. In a series of 110 patients with osteogenic sarcomas we analyzed the data of 69 patients with lower extremity lesions: of these, 54 patients had distal femur lesions and 15 had upper tibia and fibula lesions. All the patients underwent en-bloc resections and insertion of a prosthetic device. Pre- and postoperative antibiotics were given routinely. In 80% of our patients (55/69) an uneventful postoperative course was recorded with respect to wound healing. None of these required a secondary operative procedure. Débridement of the wound or débridement of the wound followed by skin grafting had to be performed in 14% (10/69) of the patients. Most of the amputations were performed early in this series of cases. After secondary surgery wound healing was uneventful in most of the patients. No patient died as a consequence of wound infection. Mixed bacterial infections were found in 13/14 patients. No single specific bacterium could be identified. One patient developed a fungal infection (aspergillosis). Eight infections were secondary to skin necrosis. In this series we later found the serious effects of the skin necrosis and slough could be reduced by early intervention with a muscle pedicle flap.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Intracortical osteosarcoma.

A case of osteosarcoma arising in the tibia of a 15-year-old boy is reported. Of particular interest was the benign roentgenographic appearance and the confinement of the tumor within the cortex of the bone, an extremely rare phenomenon consistent with origin within the primitive mesenchyme of the Haversian canals.

Adolescent↗
PubMed1984

Primary osteogenic sarcoma of the femur: a model for the use of preoperative chemotherapy in high risk malignant tumors.

The value of adjuvant chemotherapy in primary osteogenic sarcoma (OSA) is still considered controversial by some. One reason may be that various reported series include patients with widely varying prognostic variables. To address this, the effect of chemotherapy on the continuous disease-free (CNED) survival was analyzed in 100 patients aged 21 yr or less with OSA of the femur. This classically poor prognostic group of patients represented 51% of all primary OSA seen at the Memorial Sloan-Kettering Cancer Center during the study interval. This study includes all patients aged 21 yr or less with fully malignant (Grade III-IV/IV) OSA of the femur and no metastases treated from November 1973 through November 1981. The first (T-4) protocol (31 patients) consisted of high dose methotrexate (HDMTX) with leucovorin rescue, cyclophosphamide (Cyc), and adriamycin. In the second (T-7) protocol (23 patients) the dose of HDMTX was increased to 12 g/m2 for prepubescent patients, and bleomycin, Cyc, and dactinomycin replaced Cyc. The current (T-10) protocol (46 patients) uses the same CT as T-7, but patients not having a complete response of the primary tumor to preoperative CT receive additional cisplatinum (120 mg/m2) with adriamycin (30 mg/m2/day for two consecutive days). In 31 patients treated with T-4 the CNED survival was 32% with a minimum follow up of over 7 yr. On T-7, 15/23 patients with femur primaries had a CNED survival of 65% with all of the surviving patients followed for more than 5 yr. The addition of cisplatinum in T-10 has resulted in CNED survival rate of 77% in 34/44 patients (excluding two patients that died CNED during and after treatment); the median follow-up patients who are alive CNED is 33 months, with a minimum of 2 yr follow up on the last patient entered.

Adolescent↗
PubMed1983

Mesenchymal chondrosarcoma. A clinicopathologic analysis of 35 patients with emphasis on treatment.

Almost a quarter of a century has passed since mesenchymal chondrosarcoma, a rare, insufficiently studied and still poorly understood cartilage neoplasm has been described. Based on 35 cases diagnosed and treated at this Cancer Center, this study found 20 males and 15 females with an average age of 26 years (range, 6-70 years). All but five of the tumors arose in the skeleton in the femur, humerus, and ilium in five cases each, while the os calcis (a rare site for any other osseous tumor) gave rise to this tumor in four instances. Pain was the cardinal symptom in 27 patients. The lesional size varied from 4 to 18 cm (average, 9.5 cm). Histologic examination revealed nine of the tumors to be of the small cell undifferentiated types while the others were of the "hemangiopericytomatoid" variant. According to this subclassification, patients with the small cell type of lesions responded to combination chemotherapy and irradiation, as usually do other small cell sarcomas. The addition of surgical resection may be of value especially in the patients with the hemangiopericytomatoid variant. Preliminary results in the treatment of five such patients with evaluable disease suggest that this combined treatment approach is encouraging. Follow-up analysis of all patients revealed a 37.9 months median survival, and 28% to be alive at ten years.

Adolescent↗
PubMed1983

Primary osteogenic sarcoma: eight-year experience with adjuvant chemotherapy.

Since October 1973, 185 patients 21 years of age or younger with primary osteogenic sarcoma of an extremity were treated with adjuvant chemotherapy. Twenty-five of the first fifty-two patients (48%) have remained free of disease for a median of 7 years. In the next chemotherapy protocol most patients had chemotherapy prior to amputation or resection, during which time the dose of high-dose methotrexate was escalated in many patients to that needed to shrink the primary tumor. For a median of 4 years 43 of 54 patients (80%) have remained free of disease. In the current protocol, the response of the primary tumor to chemotherapy with high-dose methotrexate was used to select postoperative adjuvant chemotherapy for the patient. With the latter approach 73 of 79 patients (92%) have remained continuously free of disease for a median of 2 years. This experience demonstrates the value of chemotherapy in increasing the cure rate in osteogenic sarcoma and that the response to preoperative chemotherapy can help select postoperative chemotherapy to produce an even higher potential cure rate for osteogenic sarcoma.

Adolescent↗
PubMed1983

Pelvic Ewing's sarcoma. Advances in treatment.

In a study of eighteen patients with pelvic Ewing's sarcoma who were treated with a multidisciplinary approach, chemotherapy was effective in controlling systemic spread of the tumor. Surgery coupled with improved methods of chemotherapy provided results that were statistically superior to those obtained with radiation and chemotherapy alone in control of the local pelvic lesion. A twofold increase in the survival rate was seen at a median follow-up of thirty-six months in the patients who had the resection. Our results suggest that pelvic Ewing's sarcoma is best treated by initial chemotherapy, followed by local wide marginal resection of the pelvic lesion coupled with perimeter radiation therapy and concluded with additional chemotherapy. Survival rates of patients with pelvic Ewing's sarcoma may then approach the excellent survival rates of patients with lesions in more favorable anatomical locations.

Adolescent↗
PubMed1982

Preoperative chemotherapy for osteogenic sarcoma: selection of postoperative adjuvant chemotherapy based on the response of the primary tumor to preoperative chemotherapy.

Since June 1978, 57 patients with primary osteogenic sarcoma of an extremity were treated with high-dose methotrexate (HDMTX) and citrovorum factor rescue (CFR), Adriamycin, and the combination of bleomycin, cyclophosphamide and dactinomycin (BCD) given for 4-16 weeks prior to definitive surgery. Histologic examination of the resected primary tumor determined the effect of preoperative chemotherapy with many primary tumors showing greater than 90% tumor necrosis attributable to preoperative chemotherapy. All patients having this favorable effect of chemotherapy on the primary tumor were continued on the same chemotherapy regimen postoperatively (regimen B). However, in those patients not having a good effect of preoperative chemotherapy on the primary tumor, HDMTX with CFR was subsequently deleted from their postoperative chemotherapy and they were placed on a regimen containing cisplatinum at the dose of 120mg/M2 with mannitol diuresis combined with Adriamycin in addition to BCD (regimen A). In the current study, 35 of the 57 patients did not demonstrate a good effect of chemotherapy on the primary tumor and were assigned to regimen A postoperatively. Of these 35 patients, 32 (91%) have remained continuously free of recurrent or metastatic disease from 6-34 months following the start of therapy. Among the 22 remaining patients having a good histologic response and treated with regimen B postoperatively, there has been only one relapse in a patient who had a local recurrence in the area of an inadequately resected primary tumor three months after the cessation of chemotherapy. Thus, 53 of 57 patients (93%) are continuously with no evidence of recurrent or metastatic disease from 6-35 months (median, 20 months) from the start of treatment. This study demonstrates the value of thorough histologic examination in predicting survival in responding patients and in helping identify patients whose disease-free survival rate can be substantially increased if they are given alternative postoperative adjuvant chemotherapy after failing to have a good response to preoperative chemotherapy. This individualized chemotherapeutic strategy has yielded the highest disease-free survival rate reported to date for osteogenic sarcoma.

Antineoplastic Agents↗
PubMed1982

Bone infection caused by debaryomyces hansenii in a normal host: a case report.

Debaryomyces hansenii was isolated from a cystic lesion in the distal tibia of a healthy 23-year-old woman. Ascospores were demonstrated when the organism was incubated at 25 but not at 30 degrees C. Electron microscopy was necessary to demonstrate the warty surface of the ascospore wall. Growth was inhibited in vitro by low concentrations of amphotericin B, 5-fluorocytosine, miconazole, and ketoconazole. Four previous cases of infection caused by Debaryomyces spp. and one caused by the related fungus Torulopsis candida were reviewed.

Adult↗
PubMed1982

A 17-year review of cryosurgery in the treatment of bone tumors.

Depending on size of the lesion, cryosurgery may be effective (as it is in other fields of oncology surgery) in reducing the morbidity of en bloc excision. For benign lesions, cryosurgery may lessen the extent of curettage and, therefore, the need for autologous iliac bone grafts. Cryosurgery also reduces the local recurrence rate, and, probably because of devitalization of tumor cells, lessens the rate of malignant degeneration and metastases. The lower rate of malignant degeneration in giant cell tumor is dramatic and statistically significant when compared to curettage+/- phenol washings. In addition, good functional results are compelling reasons for cryosurgery in preference to other methods of reducing tumor burden. Radiation may be avoided as, for example, in aneurysmal bone cysts. The need for supplementary radiation therapy, i.e., 3500 rads, is substantially lessened, and, therefore, may eliminate the possibility of secondary radiation sarcoma.

Amputation, Surgical↗
PubMed1981

Ewing's sarcoma: ten-year experience with adjuvant chemotherapy.

Since May 1970, 67 consecutive patients with primary (nonmetastatic) Ewing's sarcoma were treated with adjuvant chemotherapy (CT) in addition to radiation therapy (RT) or surgery for the primary tumor. The first 19 patients were treated with four-drug sequential CT (T-2). The second protocol was a seven-drug induction combination CT (T-6) followed by T-2 maintenance CT; in both protocols CT was continued for 18 months. The current protocol (T-9) consists of combination CT given continuously for a period of 9 months. Of the entire group of 67 patients, 47 (70%) had axial and proximal lesions (pelvis, spine, rib, humerus, and femur) and 20 (30%) had distal lesions (forearm, leg, and foot); 53/67 (79%) are surviving free of disease 12--118 months (median 41 months) from the start of treatment. Fifteen of 23 (65%) patients with axial lesions, 19/24 (79%) patients with proximal lesions, and 19/20 (95%) patients with distal lesions are free of disease. Disease-free survivors include 28/39 (72%) male patients and 25/28 (89%) female patients. Thirty-four patients had RT, and 33 had surgery or surgery and RT, in addition to chemotherapy, for local treatment. The disease-free survival rate was 76% in the RT group and 82% in the surgery group; failure in the RT group was attributable to local recurrence in 7/34 (21%) patients. Recent experience with T-9 CT has demonstrated that CT given prior to RT or surgery can cause a great reduction in the size of the primary tumor while allowing the pathologically-eroded bone to heal prior to the initiation of RT; this also allows the high-risk patient with an axial primary (pelvis or spine) to tolerate the aggressive CT needed to prevent distant metastases. In addition to dramatically increasing survival in patients with Ewing's sarcoma, combination CT has helped achieve permanent local control. The superior survival rates for all sites of primary tumor are attributable to the early use of aggressive combination CT.

Antineoplastic Agents↗