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Biomedical subjects

S B Murphy

Publications and source records attributed to S B Murphy.

At least 37 records · Page 2Linked to original sources
PubMed1999

Surgical correction of acetabular dysplasia in the adult. A Boston experience.

Acetabular redirection surgery is the mainstay of treatment for the symptomatic, dysplastic hip. The authors' experience with the Salter innominate osteotomy, Wagner spherical acetabular osteotomy and the modified Bernese periacetabular osteotomy shows that major acetabular redirection surgery can reliably improve the structure of the dysplastic hip and delay or prevent secondary osteoarthrosis. The limited correction achieved by the Salter innominate osteotomy suggests this procedure generally should be reserved for younger patients with mild dysplasia. The modified Bernese periacetabular osteotomy is the authors' current preferred method of treating acetabular dysplasia, even in the presence of mild to moderate secondary osteoarthrosis.

Acetabulum↗
PubMed1998

[The Boston concept. peri-acetabular osteotomy with simultaneous arthrotomy via direct anterior approach].

To this point, we have only a relatively short term followup in 32 patients with known labral lesions who have been treated by combined periacetabular osteotomy (PAO) and debridement of the damaged anterior labrum. A positive clinical history in association with pain demonstrated with the impingement test of flexion-adduction-internal rotation nearly always indicates macroscopic pathology within the anterior portion of the hip joint. Labral lesions associated with acetabular dysplasia seem more common with increasing age. Labral lesions seem to correlate with arthrosis. We suspect that uncorrected impinging lesions of the anterior rim have led to some of our early clinical failures after PAO. We feel that intra-articular treatment of certain impinging lesions may improve the clinical outcome in these patients. Correction of the pathological mechanics in the mature, dysplastic hip certainly requires restoration of stability by reorienting osteotomy. If intra-articular derangements of the anterior rim are also present, though, intra-articular surgery may also be necessary to optimize the outcome. Our early results suggest that the earlier and more complete the correction of the disordered mechanics in the dysplastic hip, the more complete and long-lasting will be both relief of clinical symptoms and preservation of a joint free from arthrosis. Anterior arthrotomy to explore the anterior rim, carried out at the time of PAO, employing the direct anterior abductor-sparing approach (DAA), seems a safe and useful adjunct in treating the mature, dysplastic hip. Much longer clinical followup and larger treatment groups will be necessary to allow firm conclusions concerning optimal treatment programs for different patient subgroups of the adult hip dysplasia syndrome.

Acetabulum↗
PubMed1997

Treatment of children and young adults with early-stage non-Hodgkin's lymphoma.

BACKGROUND: Children and young adults with early-stage non-Hodgkin's lymphoma have an excellent prognosis, but treatment is prolonged and is associated with many side effects. We performed two studies to determine whether therapy could be simplified. METHODS: Between 1983 and 1991, we conducted two consecutive trials in children and young adults (age, <21 years) with early-stage non-Hodgkin's lymphoma. In the first trial, patients were treated for 9 weeks with induction chemotherapy consisting of vincristine, doxorubicin, cyclophosphamide, and prednisone, followed by 24 weeks of continuation chemotherapy with mercaptopurine and methotrexate. Half the patients were randomly assigned to receive involved-field irradiation. In the second trial, after the 9 weeks of induction chemotherapy, the patients were randomly assigned to receive 24 weeks of continuation chemotherapy or no further therapy. RESULTS: A total of 340 patients were enrolled in the two trials, 12 of whom did not have complete remissions. One hundred thirteen patients received nine weeks of chemotherapy without radiotherapy, 131 received eight months of chemotherapy without radiotherapy, and 67 received eight months of chemotherapy with radiotherapy. At five years, the projected rates of continuous complete remission were 89, 86, and 88 percent for the three groups, respectively. At five years, event-free survival among the patients with early-stage lymphoblastic lymphoma was inferior to that among the patients with other subtypes of lymphoma (63 percent vs. 88 percent, P<0.001). Continuation therapy was effective only in patients with lymphoblastic lymphoma. CONCLUSIONS: A nine-week chemotherapy regimen without irradiation of the primary sites of involvement is adequate therapy for most children and young adults with early-stage, nonlymphoblastic non-Hodgkin's lymphoma.

Adolescent↗
PubMed1997

Lymphocyte predominant Hodgkin disease: clinico-pathologic features and results of treatment--the Pediatric Oncology Group experience.

PURPOSE: In this report, the Pediatric Oncology Group (POG) experience with lymphocyte predominant Hodgkin Disease (LPHD) in children is reviewed. MATERIALS AND METHODS: From 1984-1993, the POG conducted 3 clinical trials for advanced stage HD and 2 for early stage HD. There were 26 cases of LPHD in 613 patients in these trials. Patients' ages ranged from 3.1-17.8 years (mean of 12.9 years). There was a marked male predominance. RESULTS: Histologic subtypes were 17 nodular, 8 diffuse pattern; 1 was indeterminant. The sites involved at diagnosis were primarily the peripheral lymph nodes. Fourteen patients had stage (S) I disease; 9 had SII; 3 had SIII; there was no SIV disease. Only 4 of 26 patients had B symptoms. All 26 patients achieved complete remission, 10 with radiotherapy, 6 with chemotherapy and 10 with combined modality therapy. Treatment was not uniform since patients were registered on different protocols. Event-free survival after 5 years was 86.5 percent. Two patients developed and succumbed to large cell, T-cell type, non-Hodgkin lymphoma (NHL). CONCLUSIONS: Optimal treatment for LPHD should focus on efforts to limit the risk of second malignancy.

Adolescent↗
PubMed1997

Fractionated cylophosphamide and back to back high dose methotrexate and cytosine arabinoside improves outcome in patients with stage III high grade small non-cleaved cell lymphomas (SNCCL): a randomized trial of the Pediatric Oncology Group.

BACKGROUND: The Pediatric Oncology Group (POG) conducted a two-arm, randomized study for the treatment of children and adolescents with stage III small, non-cleaved cell lymphoma (SNCCL). Regimen A, based on the group's previous best treatment for this group of patients, included cyclophosphamide (CTX) and high-dose methotrexate (MTX), as well as vincristine (VCR), prednisone (PRED), and intrathecal (IT) chemoprophylaxis. Regimen B, based on a single institution pilot study (Total B therapy), consisted of two rapidly alternating chemotherapy combinations (CTX, VCR, doxorubicin; MTX, and cytarabine (Ara-C) plus coordinated IT chemotherapy. PROCEDURE: One hundred thirty-four consecutive patients were entered on this study. Seventy patients were randomized to Regimen A, and 64 patients to Regimen B. One hundred and twenty-two patients are eligible for response. RESULTS: Complete remission (CR) was achieved by 81% (52/64) of patients on Regimen A, and 95% (55/58) of patients on Regimen B (p=0.014 one-sided). The two-year event-free survival (EFS) is 64% (SE=6%) on Regimen A, and 79% (SE=6%) on Regimen B (p=0.027 by one-sided logrank test). No patient has relapsed on either regimen after a year from diagnosis, although one patient had a second malignancy at day 371. Severe, but manageable, hematologic toxicity was seen in the majority of patients on both regimens, but was more frequent on Regimen B. CONCLUSIONS: We conclude that the cure rate in stage III SNCCL is significantly improved with the use of a short, six-month chemotherapy regimen of fractionated CTX alternated with coordinated MTX and Ara-C. Results suggest that drug schedule, not simple drug selection, influences outcome.

Adolescent↗
PubMed1997

[The trochanteric flip osteotomy.].

GOAL OF SURGERY: Easy access to the posterior, superior and anterior joint capsule through an osteotomy which reduces the risk of complications and the incidence of non-union. INDICATIONS: Hip joint revision with or without intertrochanteric osteotomy, periarticular ossifications, difficult total hip procedures, exchange procedures. CONTRAINDICATIONS: Absolute: None Relative: Distal transfer of the trochanter. PREOPERATIVE WORK UP: Radiographs in 2 planes (anterior-posterior pelvis+"false profile" hip). POSITIONING AND ANAESTHESIA: Lateral decubitus. General anaesthesia. SURGICAL TECHNIQUE: In lateral decubitus the greater trochanter will be osteotomized from posterior leaving a 1 to 1.5 cm thick bony wafer uniting the insertion of the gluteus medius and minimus with the origin of the vastus lateralis. The trochanteric crest remains untouched. After refixation with nonresorbable sutures #3 the fragment is not subjected to a unidirectional tension by the abductors which could interfere with the consolidation. POSTOPERATIVE MANAGEMENT: Bed rest with lower limb in neutral position. Mobilization with 2 canes on the 2nd postoperative day. The timing of partial weight bearing depends on the type of surgery. Abductor exercises after 6 weeks. POSSIBLE COMPLICATIONS: Bony wafer too thin or too thick. Inadequate refixation. Delayed consolidation. Cranial migration of the greater trochanter. RESULTS: Between 1991 and 1994 41 patients were operated. Diagnoses, see Table 1. Method of refixation: see Table 2. After 21+/-9 months 39 patients could be reexamined clinically, and radiological after 17+/-11 months: 38 osteotomies consolidated. Cranial migration varied between 0 and 8 mm. 25 patients were free of symptoms, 12 had slight and 2 moderate pain over the trochanter. Avulsion of wire cerclage: 2, foreign body irritation: 2 necessitating implant removal.

English Abstract↗
PubMed1997

National cancer clinical trials: children have equal access; adolescents do not.

PURPOSE: To determine whether adolescents with cancer, who in comparison to younger patients have a higher cancer incidence and lower mortality reduction, have equal access to national cancer clinical trials. METHODS: The ethnic/racial distribution of 29,859 subjects < 20 years of age entered onto National Cancer Institute-sponsored clinical trials between January 1, 1991, and June 30, 1994, was compared with the expected distribution of patients of the same age in the United States. RESULTS: The Children's Cancer Group and Pediatric Oncology Group had 29,134 (97.6%) of the total study entries among < 20-year-old subjects during the 3.5 years of surveillance. The adult cooperative groups accounted for < 3% of the clinical trials entries in the 15-19-year age range. When analyzed nationally by region, the under-representation of the older adolescent subjects was universal. From other analyses, the two pediatric cooperative groups were estimated to have registered > 94% of the children < 15 years of age who were expected to have been diagnosed to have cancer, but only 21% of the cancer patients in the 15-19-year age group. CONCLUSIONS: The national pediatric cancer cooperative groups allow the majority of American children < 15 years of age and their families equal opportunity to access clinical cancer trials, regardless of race or ethnicity. Among patients 15-19 years of age, however, > 75% are not being enrolled by any cooperative group sponsored by the National Cancer Institute. Thus, older adolescents are disadvantaged with respect to access to the national clinical trials, regardless of their race or ethnicity.

Adolescent↗
PubMed1997

Comparison of predicted and measured contact pressures in normal and dysplastic hips.

Hip dysplasia, a congenital and developmental deformity characterized by malorientation and a reduction of contact area between the femur and acetabulum, is the most common cause of osteoarthritis of the hip. According to current estimates, dysplasia accounts for nearly 76% of all cases of osteoarthritis, and many who are affected require a total hip replacement before the age of 50. It is theorized that in the poorly oriented and deformed pelvis, a reduction in contact area leads to an increase in contact pressure during normal activities. Currently, clinicians attempt to reposition the joint, assuming that improving the position of the existing contact surface will lead to decreased pressures. It is also assumed that improving certain geometric parameters correlates indirectly with decreased contact pressures. Neither these simple estimates nor other non-invasive models have ever been shown to be related to contact pressure. The purpose of this study was to evaluate a computerized method of predicting hip joint contact pressures, which applies known hip joint reaction forces to the three-dimensional surface of the hip joint. To this end, cadaveric and plastic pelvic models were developed to test whether the computer model could predict the magnitude and location of maximum pressure. Mechanical testing revealed that the computer model could be used to predict pressure in cadaveric pelves at prescribed locations (r2 = 0.64). The computerized model could also be used to predict the magnitude and location of maximum pressure in a series of plastic models where the load vector and the degree of dysplasia were parametrically varied (r2 = 0.7). These findings suggest that the computer model may be useful in identifying patients who will fail osteotomy or whether they can be used to select the best osteotomy for each patient.

Aged↗
PubMed1997

The spectrum of mucosa-associated lymphoid tissue lesions in pediatric patients infected with HIV: A clinicopathologic study of six cases.

Mucosa-associated lymphoid tissue (MALT) lesions in nonimmunocompromised individuals include reactive lymphoid proliferations and both low- and high-grade lymphoid neoplasms. These lesions occur at extranodal mucosal sites, such as the gastrointestinal tract, bronchus, salivary gland, and other locations. The spectrum of MALT lesions in children with HIV infection had not been previously described. In this study, six cases that demonstrated the spectrum of MALT lesions in pediatric patients, aged 28 months to 23 years, who had HIV infection were described. Half the patients acquired the infection perinatally, and half acquired it by transfusion. Mucosal sites of involvement included the salivary gland (4 patients), bronchiolar mucosa (2 patients), and oropharyngeal mucosa (1 patient). One patient had lesions in lung and oropharynx sequentially; all others had involvement of solitary sites. The histologic diagnoses included myoepithelial sialadenitis (MESA), MESA with low-grade MALT lymphoma, typical low-grade MALT lymphoma, diffuse large cell lymphoma (DLCL), and atypical pulmonary lymphoid hyperplasia and lymphoid interstitial pneumonitis complex. The two cases of high-grade DLCL were confined to mucosal sites (tonsil and parotid); in one of these patients, a previous biopsy specimen showed a MALT lesion with low-grade features. In two cases, quantitation of the Epstein-Barr virus (EBV) genome by the polymerase chain reaction showed a very high copy number in peripheral blood mononuclear cells but a low copy number in the MALT lesion, which suggested that MALT lesions may not be directly associated with EBV infection. Two patients who had high-grade tumors (DLCL) were successfully treated with chemotherapy and radiation therapy. The remaining patients, all of whom had low-grade MALT lesions, received either corticosteroids or alpha-interferon or no specific therapy; in all patients, the lesions followed an indolent clinical course. Clinicians and pathologists should be alert to the possibility that MALT lesions, including MALT lymphomas, may be present in children who have AIDS.

Adolescent↗
PubMed1997

Benign and malignant smooth muscle tumors containing Epstein-Barr virus in children with AIDS.

Smooth muscle tumors (leiomyosarcomas) are the second most prevalent malignancy of children with the acquired immunodeficiency syndrome (AIDS). We have investigated the tumors, plasma, and peripheral white blood cells of eight children with AIDS with smooth muscle tumors for evidence of tumor association with human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV). Very low levels of HIV were found in the tumors of the AIDS patients, probably resulting from blood-borne carriage of virus. These smooth muscle tumors had very high quantities of EBV in all the tumor cells by in situ hybridization, with an average of 4.5 EBV genomes per cell by quantitative polymerase chain reaction amplification. Increased amounts of EBV were found in the peripheral blood cells of two AIDS patients before the time of tumor diagnosis. EBV clonality studies demonstrated different monoclonal EBV infection of two separate colonic tumors from one patient, and dual or mixed monoclonal EBV infection in another patient. The muscle cells of leiomyomas and leiomyosarcomas of patients with AIDS demonstrated prominent staining with antibodies to the EBV receptor. The uniform distribution and striking amount of EBV in the tumor cells demonstrates that EBV is capable of infecting smooth muscle cells and that these cells support EBV replication. Clonal EBV proliferation suggests that EBV infection occurs at an early stage of tumor development. These findings indicate that EBV has a causal role in the oncogenesis of leiomyosarcomas of patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Use of an anti-ALK antibody in the characterization of anaplastic large-cell lymphoma of childhood.

BACKGROUND: Anaplastic lymphoma kinase (ALK) is a tyrosine kinase inappropriately expressed in lymphoid tissue involved by CD30+ anaplastic large-cell lymphoma (ALCL) with the translocation t(2;5)(p23;q35)(, which juxtaposes the nucleophosmin gene (NPM) with that encoding ALK, resulting in a hybrid (NPM-ALK) message. PATIENTS AND METHODS: A polyclonal antibody against residues of the kinase portion of NPM-ALK (designated anti-ALK 11) was tested for clinical utility in paraffin sections of 44 cases of pediatric large-cell lymphoma (LCL) and 17 additional lymphoma cases, by streptavidin-biotin-alkaline phosphatase method. RESULTS: Nineteen of 20 CD30+ cases (the majority exhibiting anaplastic morphology) labeled with anti-ALK 11, and 5/28 CD30- cases were also ALK+ (3 T cells, 1 null cell, and 1 B cell). Sixteen of 17 B-cell pediatric LCLs were negative, as were 6/6 cases of Hodgkin's disease and 7/7 cases of adult B-cell lymphoma. In pediatric LCLs with adequate follow-up (24/44 ALK+), there was no significant association between ALK expression and two-year event-free survival, similar to the finding reported previously for CD30 expression in these cases. CONCLUSION: We conclude that the majority of pediatric CD30+ ALCLs show ALK overexpression, consistent with the presence of the t(2;5)-encoded NPM-ALK fusion, but that the clinical significance of this entity remains unproven.

Adult↗
PubMed1996

Cancers in children with HIV infection.

Malignancies in children with HIV infection have not been as frequent as expected, but they still constitute a fertile area for clinical and basic research. Non-Hodgkin's lymphomas are the most frequent malignancies of children with AIDS and are curable diseases with standard chemotherapy. Leiomyomas and leiomyosarcomas have become the second leading cancer of children with HIV infection and are clearly associated with EBV infection. Treatment for these lesions has not been as successful as that for lymphomas. Other infrequent atypical lymphoproliferative lesions of these patients can often be categorized in the MALT group. Some of these are low-grade lymphomas, whereas others can progress to high grade. The diagnosis of Kaposi's sarcoma in children with AIDS should be carefully reviewed by pathologists experienced with these cases. The diagnosis of KS in children must be made with special care, because some other lesions of HIV-infected children (such as prominent vascularity in lymph nodes) can be confused with KS. Other tumors of these patients are rare and probably are no more frequent than would be expected in the normal population. Because malignancies in children with AIDS are rare, it is important that each one be studied completely with regard to type and incidence, risk factors, and biologic features. To this end, the Pediatric Oncology Group (POG) has established a national registry and treatment protocols. Patient information as well as fresh, frozen, and fixed specimen studies are coordinated through the POG Statistical Office in Gainesville, Florida (telephone, 904-392-5198; FAX, 904-392-8162). The collaborative efforts of all physicians treating children with AIDS and malignancies will be needed to advance our knowledge and efficacy in treating these diseases.

Central Nervous System Neoplasms↗
PubMed1995

Association of Epstein-Barr virus with leiomyosarcomas in young people with AIDS.

BACKGROUND: Children with the acquired immunodeficiency syndrome (AIDS) have an unusually high incidence of smooth-muscle tumors (leiomyomas and leiomyosarcomas) in addition to malignant lymphomas. We tested the hypothesis that the smooth-muscle tumors in these children are associated with the Epstein-Barr virus (EBV). METHODS: Tissue specimens of five leiomyosarcomas and two leiomyomas from six children with AIDS were studied for evidence of the human immunodeficiency virus (HIV) and EBV by in situ hybridization and quantitative polymerase chain reaction (PCR). Comparison specimens included samples of leiomyosarcoma and leiomyoma from HIV-negative children. EBV clonality of leiomyosarcomas was determined by Southern blot analysis with oligonucleotide probes for EBV terminal-repeat fragments. Tumor specimens were tested by immunoperoxidase staining for infiltration by B lymphocytes and expression of the EBV receptor. Serologic testing for EBV was performed. RESULTS: In situ hybridization showed EBV genomes in all muscle cells of the five leiomyosarcomas and the two leiomyomas from the six HIV-infected children. Quantitative PCR demonstrated strikingly high levels of EBV in tumor tissue, with as many as 4.3 genome copies per cell. Two colonic leiomyosarcomas obtained from different sites at different times from one patient contained different episomal EBV clones, signifying the presence of distinct monoclonal EBV-related tumors. We found biclonal EBV infection in the leiomyosarcoma of another patient. No EBV was detected in normal muscle or tumor specimens from HIV-negative patients. Immunostaining for the EBV receptor was strongly positive in six of the seven leiomyomas and leiomyosarcomas from the patients with AIDS. CONCLUSIONS: EBV can infect smooth-muscle cells, at least in patients with AIDS, and it may contribute to the pathogenesis of leiomyomas and leiomyosarcomas in children with AIDS. EBV seems to play no part in smooth-muscle tumors in HIV-negative children.

AIDS-Related Opportunistic Infections↗