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Biomedical subjects

S R Carter

Publications and source records attributed to S R Carter.

At least 55 records · Page 3Linked to original sources
PubMed1999

Extensible endoprostheses of the humerus after resection of bone tumours.

We carried out extensible endoprosthetic replacement of the proximal or total humerus in 18 children aged between six and 12 years, after resection of primary bone tumours mainly for osteosarcoma and Ewing's sarcoma. In 11 patients we performed 44 lengthening procedures, with an average of two per child annually and a mean total extension of 29.9 mm per patient. We were able to achieve lengthening of the operated limb with few complications and a mean functional rating of 79.3% according to the Enneking system. Progressive lengthening of these prostheses does not adversely affect the overall function of the arm, and superior subluxation of the head of the prosthesis has not been a problem.

Bone Neoplasms↗
PubMed1999

Endoprosthetic replacement of the proximal tibia.

We have performed endoprosthetic replacement after resection of tumours of the proximal tibia on 151 patients over a period of 20 years. During this period limb-salvage surgery was achieved in 88% of patients with tumours of the proximal tibia. Both the implant and the operative technique have been gradually modified in order to reduce complications. An initial rate of infection of 36% has been reduced to 12% by the use of a flap of the medial gastrocnemius, to which the divided patellar tendon is attached. Loosening and breakage of the implant have been further causes of failure. We found that the probability of further surgical procedures being required was 70% at ten years and the risk of amputation, 25%. The development of a new rotating hinge endoprosthesis may lower the incidence of mechanical problems. Limb salvage for tumours of the proximal tibia is fraught with complications, but the good functional outcome in successful cases justifies its continued use.

Adolescent↗
PubMed1999

Osteosarcoma of the pelvis.

Over a 25-year period we have treated 36 patients with osteosarcoma of the pelvis. Of the tumours, 24 (67%) were primary osteosarcomas and 12 (33%) arose either after irradiation or in association with Paget's disease. Six patients had a hindquarter amputation and 12 were treated by a limb-salvage procedure with intrapelvic excision. The five-year survival rate of all the patients with pelvic osteosarcoma was 18%, while for 17 treated by chemotherapy and surgery it was 41%. The prognosis for patients presenting with metastases or with secondary osteosarcoma was appalling and none survived after 29 months. No patient over the age of 50 years when seen initially survived for a year. Youth and a good response to chemotherapy along with complete surgical excision offer the best chance of cure.

Adolescent↗
PubMed1999

Endoprosthetic replacement for primary malignant tumors of the proximal femur.

Fifty-four patients had endoprosthetic replacement of the proximal femur after resection of primary malignant or aggressive bone tumors. The mean age of the patients was 41 years. The average duration of followup was 9 years (range, 5-24 years). At the time of this review 35 patients are surviving. There were six revisions of the acetabulum and seven revisions of the femoral component. The survivorship of the prostheses without revision was 77% at 10 years falling to 57% at 20 years. There was a 13% risk of amputation and a 1.8% incidence of infection. The mean of the functional scores of the 35 living patients was 83% (range, 60%-97%). This study showed that successful long term results can be obtained with cemented massive endoprostheses despite the incidence of recognized complications including polyethylene wear and aseptic loosening.

Adolescent↗
PubMed1998

Brief report: assessment of body image in survivors of childhood cancer.

OBJECTIVE: To establish preliminary reliability and validity data of the Body Image Instrument (BII), a 28-item self-report measure developed to assess body image in adolescents and young adults with cancer. METHOD: As part of a larger study assessing long-term adjustment in survivors of childhood cancer, 40 males and 27 females (mean age = 19.69 years, SD = 3.87) completed the BII and two validation measures: the SF-36 health survey and the Perceived Illness Experience measure. RESULTS: The five BII subscales--General Appearance, Body Competence, Others' Reaction to Appearance, Value of Appearance, and Body Parts--exhibited moderate to high internal reliability and concurrent validity. No significant sex differences in body image emerged, nor was age at diagnosis or time since diagnosis significantly correlated with body image. CONCLUSIONS: The measure may be of value in clinical settings, where it could be used to identify adjustment problems related to body image disturbance in pediatric cancer patients.

Adaptation, Psychological↗
PubMed1998

Eyelid disorders: diagnosis and management.

Eyelid problems range from benign, self-resolving processes to malignant, possibly metastatic, tumors. Inflammation, infection, benign and malignant tumors, and structural problems such as ectropion, entropion and blepharoptosis may occur. Fortunately, most eyelid disorders are not vision-threatening or life-threatening; however, many cause irritative symptoms such as burning, foreign-body sensation or pain. Blepharitis, or eyelid inflammation, one of the most common problems, is characterized by erythematous eyelids with accumulation of debris along the eyelid margin. Malignant eyelid tumors may be associated with lash loss and erosion of normal eyelid structures. Recognition and diagnosis of these problems are crucial to their proper management. Warm compresses and antibiotics suffice for many conditions, while excision, cryotherapy or laser treatment are required for some.

Eyelid Diseases↗
PubMed1998

The Asian lower eyelid: a comparative anatomic study using high-resolution magnetic resonance imaging.

Asian upper and lower eyelids are typically characterized by a fuller appearance than the lids of whites. Inferior extension of preaponeurotic fat and brow fat into the Asian upper lid explain the upper lid fullness and its difference from the upper lid of whites. Analogous structures in the Asian lower lid may exist to explain its full appearance. High-resolution magnetic resonance imaging (MRI) of 24 normal Asian and white lower lids was performed to evaluate differences in Asian and white lower lid anatomy. Magnetic resonance images revealed two major differences. First, the orbital fat projected further anteriorly with respect to the orbital rim in all Asian lower lids studied. No analogy with the upper lid exists for this difference. Second, the orbital fat extended further superiorly, to the inferior border of tarsus, in those Asian lower lids that did not have well defined creases. This was analogous to the preaponeurotic fat location of the Asian upper lid and different from the white lower lid. The suborbicularis oculi fat in the lower lid, the analogous structure of the brow fat pad in the upper lid, was not different in location in Asian and white lower lids. Therefore, the Asian lower lid appearance is explained by the difference in orbital fat location, which is only partly analogous to the anatomical differences between the Asian and white upper lids.

Adipose Tissue↗
PubMed1997

Skip metastases in Ewing's sarcoma: a report of three cases.

The accurate pre-operative staging of all potentially malignant tumours of bone is essential. We report three cases of Ewing's sarcoma of bone in which MR imaging identified skip metastases not visualized on either contemporary radiographs or bone scintigraphy. The implications for patient management and possible reasons for the other imaging modalities failing to reveal the skip metastases are discussed.

Adolescent↗
PubMed1997

The cost-effectiveness of limb salvage for bone tumours.

The use of endoprostheses for limb salvage in primary bone tumours is highly specialised. Studies have shown no significant difference in survival, function or quality of life between patients with limb salvage and those with amputation. We have derived a formula for calculating the ongoing costs of limb salvage with an endoprosthesis which is based on actual costs and uses historical data to show the likelihood of further surgery or revision. Comparative data for amputation are also shown. Using current prices, the cost-effectiveness of surgery with an endoprosthesis is clearly demonstrated.

Amputation, Surgical↗
PubMed1997

Reconstruction of the hemipelvis after the excision of malignant tumours. Complications and functional outcome of prostheses.

We treated 35 patients with primary malignant tumours of the periacetabular area by resection and prosthetic reconstruction of the defect. At a mean follow-up of 84 months, 15 patients (43%) were free from disease. The most common complications were deep infection (26%), local recurrence (24%) and recurrent dislocation of the hip (17%). The surviving patients achieved an average of 70% of their premorbid function. This method of reconstruction has a high morbidity and should be performed only at specialist centres, but the functional and oncological outcomes are satisfactory.

Acetabulum↗
PubMed1997

Forequarter amputation for high-grade malignant tumours of the shoulder girdle.

We reviewed 20 patients after forequarter amputation performed for high-grade malignant tumours of the shoulder girdle (Enneking grades IIB to III). The operations were classified as palliative or curative according to the resection margins and the presence of disseminated disease at the time of the surgery. There were five palliative and 15 curative procedures. Two patients died from unrelated causes, septicaemia and suicide. Eight died in the first two years, four of whom had had a palliative operation. Four died between two and five years after surgery, one after a palliative operation. Five patients are alive, at a mean of 89.4 months after surgery, four of whom are free from disease. The median survival after a palliative amputation was 20.6 months. Our overall five-year survival (palliative and curative cases) was 21.2%, for curative cases it was 30.2%. None of the patients use an artificial prosthesis. Despite the disfigurement which results from this operation, it still has a useful role to play in the management of high-grade malignant tumours of the upper limb.

Adolescent↗
PubMed1997

Growth after extendible endoprosthetic replacement of the distal femur.

We report our results in 24 children with malignant primary bone tumours of the distal femur treated with a Stanmore extendible endoprosthesis (SEER). This consists of a femoral component that can be lengthened, a constrained knee and an uncemented sliding tibial component which crosses the proximal tibial physeal plate perpendicularly. The average age of the patients at diagnosis was ten years and the mean follow-up was 4.7 years (2.5 to 7.9). The mean growth of the affected tibia was 76% (18 to 136) and of the fibula 83% (15 to 750) of the growth of the unaffected limb. Measurement of growth arrest lines showed that the mean growth of the proximal tibial physis on the affected side was 69% (43 to 100) of that of the normal side. The great variability in the growth of the physis cannot yet be explained.

Adolescent↗