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Biomedical subjects

V L Fornasier

Publications and source records attributed to V L Fornasier.

At least 73 records · Page 4Linked to original sources
PubMed1983

Spinal entheseal new bone formation: the early changes of spinal diffuse idiopathic skeletal hyperostosis.

Diffuse idiopathic skeletal hyperostosis is characterized by new bone growth at the point of insertion of ligaments and tendons to bone. We examined retrospectively the anatomical morphologic changes discernible at the insertion of spinal longitudinal ligamentous fibrous tissue to vertebral bodies. The earliest evidence of bone formation was in the "waist" of the vertebral body away from the intervertebral disc area. New bone arose along the insertion of the fibrous tissue to the anterior cortical surface of the vertebral body and progressed along the fibres at an angle to the cortical surface distinct from it until the advanced stages. With disc degeneration the 2 processes were distinct and separate. Degenerative disc disease occurred at the margin of the endplate of the vertebral body with associated changes in the disc itself. Entheseal ossification occurred remote from the margin of the intervertebral disc and remained distinct from the subjacent vertebral body as it followed the ligamentous tissue; fusion with the cortical surface of the subjacent vertebral body was only seen in the most advanced cases of disseminated idiopathic systemic hyperostosis.

Adult↗
PubMed1982

Microfilaments associated with Paget's disease of bone: comparison with nucleocapsids of measles virus and respiratory syncytial virus.

The structural characteristics and intracellular disposition of microtubules present in osteoclasts in Paget's disease of bone were compared with those of nucleocapsids in cells infected with measles virus and respiratory syncytial virus (RSV). The distribution of microtubules in pagetic osteoclasts closely paralleled that of measles nucleocapsids in monkey kidney cells, but the dimensions of the pagetic microtubules were significantly different from those of measles virus. In contrast, pagetic microtubules were not distinguishable in dimensions from RSV nucleocapsids but were dissimilar in their conformation and location. The observations support the hypothesis tht Paget's disease of bone is a slow virus disease and suggest that the virus is a pneumovirus (RSV) rather than a morbillivirus (measles).

Capsid↗
PubMed1982

Coccygeal glomus tumors: a case of mistaken identity?

We undertook an anatomical and histological study to differentiate glomus-cell tumors of the pericoccygeal tissues from the normal coccygeal body. Removal of the coccyx was performed on five consecutive autopsy specimens from patients with no history of coccygeal symptoms. In each specimen, the coccygeal body (glomus coccygeum) was identified grossly and histologically. The histological appearance was indistinguishable from that of photomicrographs published in case reports of patients with glomus tumors of the coccyx. It is likely that the so-called tumors reported previously were in actuality normal glomus bodies.

Arteriovenous Anastomosis↗
PubMed1982

Renal osteodystrophy in children with chronic renal failure: an unexpectedly common and incapactating complication.

The incidence, age at onset, and progression of the biochemical, radiographic, and histologic characteristics of renal osteodystrophy were studied in 50 children in whom chronic renal failure had been recently diagnosed. During a ten-year observation period, 19 patients progressed to end-stage renal failure and radiographic signs of renal osteodystrophy developed in 15 of these (79%). Renal osteodystrophy developed in all nine patients whose chronic renal failure was diagnosed before 3 years of age and in six of the ten children with later onset of failure. The mean interval from diagnosis of renal failure to development of osteodystrophy was 1.4 years. Radiographically, growth zone lesions predominated in the younger children, whereas cortical erosions were more prevalent in the older children. Histologic examination, performed in 38 patients, showed both defective mineralization and excessive resorption and was a more sensitive diagnostic index than radiography. Noticeable deformities developed in one third of the patients with osteodystrophy, despite medical treatment including vitamin D2 therapy. Deformities were particularly frequent and severe in patients whose renal failure developed in infancy. In all 13 patients whose growth patterns were studied before and after osteodystrophy developed, the onset of bone lesions was associated with a deterioration of growth, indicating that osteodystrophy plays a major role in causing the growth retardation commonly observed in children with chronic renal failure.

Adolescent↗
PubMed1982

Radical radiotherapy as primary treatment for Ewing's sarcoma distal to the elbow and knee.

This article is a review of 22 cases of Ewing's sarcoma peripheral to the elbow and knee treated with moderate dose radiotherapy, with special reference to local control, functional result and risk of irradiation induced sarcoma. Eleven patients (50%) are alive two to 16 years following radiotherapy. Two of these had local recurrences, one being salvaged by reirradiation and the other by amputation. The functional results of treatment were assessed in the nine survivors who did not have a recurrence . Eight had normal limb function and one had a 3 cm leg-length discrepancy. Nine patients in the total experience of the hospital who survived more than ten years after radiotherapy were assessed for evidence of postirradiation sarcoma and none were found. The excellent results of radiotherapy in terms of local control, function and lack of irradiation induced sarcomas is attributed to the use of moderate doses of irradiation.

Adolescent↗
PubMed1982

Angiolymphoid hyperplasia with eosinophilia: a bone lesion pathologically resembling Kimura's disease of skin. A report of two cases.

Primary osseous lesions morphologically identical to the soft tissue entity known as angiolymphoid hyperplasia with eosinophilia were diagnosed by means of light and electron microscopy in two men, ages 20 and 27 years, respectively. The characteristics of the lesions were reactive rather than neoplastic. The soft tissue counterpart of this lesion has shown no indication of aggressive behavior nor of a potential to metastasize. Further investigations are necessary to determine whether a similar benign behavior can be established for angiolymphoid hyperplasia with eosinophilia arising primarily in bone.

Adult↗
PubMed1982

The femoral head remnant in resurfacing arthroplasty.

The femoral head remnant was examined in six patients after Indiana resurfacing arthroplasty. Four hips failed by femoral neck fracture and two by acetabular loosening. Three of the four specimens that failed by fracture had total osteonecrosis, as assessed by histological criteria. The tissue did not evidence foreign body response to methyl-methacrylate, suggesting that osteonecrosis may have occurred at the time of resurfacing arthroplasty. Bony remodeling at the site of fracture indicates that fracture may have occurred through a weakened zone at the junction of viable and necrotic bone. In contrast, examination of the femoral specimens removed owing to acetabular loosening revealed viable bone, membrane formation and a foreign body reaction. The small number of specimens and lack of tetracycline labeling prohibit firm conclusions. These observations nevertheless suggest that resurfacing arthroplasty may, in some cases, cause osteonecrosis of the femoral head remnant, which may play a role in femoral neck fracture. Efforts should be made to obtain the femoral head remnant at autopsy and at revision surgery when indicated so that the state of the femoral head remnant after resurfacing arthroplasty and its role in the success or failure of the various procedures could be better understood.

Adult↗
PubMed1981

Intrahepatic cholestasis with predominant pericentral deposition in systemic amyloidosis.

Liver involvement in amyloidosis is rarely associated with intrahepatic cholestasis. The cases recorded in the literature indicate that there is a tendency toward periportal deposition, leading to centrilobular cholestasis. Our case was most interesting in that the amyloid deposition was most severe in the centrilobular area. Presumably there was still sufficient compression of canaliculi at the periportal level to produce obstruction of the bile flow. This would appear to be a less common but distinct variant of systemic amyloidosis with associated obstructive jaundice.

Amyloidosis↗
PubMed1980

Radiotherapy of chondrosarcoma of bone.

A retrospective analysis of 31 cases of chondrosarcoma of bone treated by radiotherapy at the Princess Margaret Hospital between 1958 and 1976 is presented. In comparison with other large series, our group of patients were found to have been unfavourably selected with respect to the known prognostic factors: histology (39% mesenchymal and dedifferentiated), site (75% arising in the trunk and head and neck), adequacy of operative treatment (none having had a complete surgical excision), and presenting symptoms (two-thirds presenting with pain). Twelve patients with primary (good, moderate, and unknown differentiation) chondrosarcoma were radically irradiated; 6 of these 12 have been alive and well without tumor for periods ranging from three and half to 16 years and 3 of these are alive and well for 15 years or more following radiotherapy. The other 6 patients responded or disease stabilized following radiotherapy for periods ranging from 16 months to eight years. One poorly differentiated tumor was radically irradiated and did not respond. Eleven patients were irradiated palliatively (5 dedifferentiated and mesenchymal, 4 secondary, and 2 primary chondrosarcomas), generally with low doses of irradiation, and only 4 responded transiently for periods ranging from three to 12 months. Seven patients with mesenchymal and dedifferentiated tumors were radically irradiated. Four responded or disease stabilized, and 1 of these patients was alive and well at 3 years; 3 did not respond. Six died with distant metastasis. It is concluded that chondrosarcoma of bone is a radioresponsive tumor and the place of radiotherapy in the treatment of this disease and the reason for its being labelled a radioresistant tumor are discussed. The problems of assessing response of chondrosarcoma to therapy are also discussed. It is suggested that chemotherapy may have a role in the management of mesenchymal and dedifferentiated chondrosarcoma.

Bone Neoplasms↗
PubMed1980

Dissecting aneurysm of the cerebral arteries. Case report.

A spontaneous dissecting aneurysm of the left middle cerebral artery with extension into its major branches is reported in a 23-year-old man. The characteristic pathological and angiographic findings are demonstrated, including the rarely documented progression of this lesion. The etiological factors, the early recognition by the neuroradiologist, and the possibility of immediate treatment are briefly discussed in this report.

Adult↗
PubMed1980

Pseudomalignant myositis ossificans: heterotopic new-bone formation without a history of trauma.

Circumscribed heterotopic new-bone formation without a history of trauma is termed pseudomalignant myositis ossificans due to the diagnostic confusion of this benign lesion with malignant lesions. In 20 per cent of the published cases in which there were diagnostic problems, the patient underwent a radical procedure. Roentgenographically, pseudomalignant myositis ossificans is a circumscribed, radiopaque lesion with a central lucent zone that is separated from the underlying cortex by a radiolucent line. Histologically, a characteristic zoning pattern of peripheral maturation is present, the central proliferating zone usually causing the diagnostic problems. The ultrastructure of the lesion shows a regular mineralization front but an abnormal collagen periodicity of 300 angstroms. Excision is indicated for diagnosis and for relief of mechanical block or pain.

Adolescent↗
PubMed1979

Postirradiation sarcoma of bone: a perspective.

Ten cases of irradiation induced sarcoma of bone which fulfilled Cahan's criteria were seen in a twenty year period at the Princess Margaret Hospital. The overall incidence of this complication is 0.035% of all irradiated five year survivors. Combining our data with three other large series presented in the literature, a dose complication curve could be deduced. On the basis of the human and animal data reviewed, it was concluded that the risk of radiation induced sarcoma is so low in the dose range of modern radiotherapeutic practise that it does not represent a contraindication to the use of radiation therapy.

Adult↗
PubMed1979

Morton's neuroma--pathogenesis and ultrastructure.

In an attempt to clarify the pathogenesis of Morton's neuroma, 106 documented cases were analyzed by multiple staining techniques and electron microscopy. The lesion was found to consist of a progressive fibrosis which enveloped and disrupted nerves and arteries. No evidence of a nerve proliferation nor of a specific inflammatory process was encountered. Based on these observations, it is concluded that repeated trauma in the connective tissue elements, including nerves and arteries in the interdigital clefts, lead to a reactive overgrowth of connective tissue (scarring) that disrupts the nerves and the arteries. Sclerosis of the arteries and the narrowing of their lumen contributes to ischemia and further nerve atrophy. The nerves and arteries caught in this reactive scar become more sensitive to pressure and cause characteristic pain.

Adult↗
PubMed1979

The effect of calcitonin on fracture healing.

Corrective osteotomy of the long bones may be required in patients with Paget's disease. Experiments on rabbits suggest that the safety of the procedures is of concern while the patient receives Calcitonin. Twenty-four rabbits were divided into 4 groups of 6 animals. Half of each group received maintenance doses of Calcitonin subcutaneously. In all animals the left and right ulnae were osteotomized through middiaphysis. The right ulna was fixed with a "mini" dynamic compression plate. The left ulna was not immobilized. Each group of animals was sacrificed at successive intervals of 3 weeks. Histologically, no difference was found in the healing of the fracture of test or control animals. Radiographically, the fracture line persisted longer in animals receiving Calcitonin (6 weeks vs 3 weeks). All fractures healed by 9 weeks. The fracture line disappeared more rapidly in all the immobilized bones. Based on these observations, administration of Calcitonin is not a contraindication for corrective osteotomy in Paget's disease. Osteotomies should be rigidly fixed to maintain the correction achieved surgically until healing is established.

Animals↗
PubMed1979

Pathologic fractures of the hand in Paget's disease.

The radiologic features of Paget's disease of the bones of the hand are similar to involvement in other bones. Widening of the diameter of the bone and loss of cortical medullary distinction with a mottled coarsening of the trabecular pattern are the most characteristic features. In 2 cases reported here, there was a mixture of lysis and sclerosis with a preponderance of lysis. In the lytic phase the bone structure may be weakened and predisposed to pathologic fracture. Prior to the trauma that precipitated the fracture, both cases were asymptomatic. However, the occurrence of fractures in the involve bones led to the consideration of more ominous possibilities in a differential diagnosis. Recognition of the occurrence of Paget's disease in the bones of the hand or without superimposed pathologic fracture may prevent unnecessary surgical intervention.

Female↗
PubMed1978

Histologic changes in Paget's disease treated with calcitonin.

In recent years the use of calcitonin in the medical treatment of Paget's disease of bone has been gaining in popularity. Seventeen patients on long term calcitonin therapy showed objective morphologic evidence of improvement in the quality of bone matrix deposition, in the trabecular organization, and in the parameters used to evaluate the rates of bone turnover. The usefulness of bone biopsy and fine detail radiography of the biopsy core in evaluating the progress of disease and the effects of therapy is discussed. It is concluded that the longer the period of therapy and follow-up, the higher the proportion of patients showing histologic evidence of improvement.

Aged↗
PubMed1978

Hemangiopericytoma of the spinal canal. Report of three cases.

Hemangiopericytoma is a vascular neoplasm consisting of capillaries outlined by an intact basement membrane that separates the endothelial cells of the capillaries from the spindle-shaped tumor cells in the extravascular area. These neoplasms are found in soft tissues but have rarely been shown to involve the spinal canal. This is a report of three such cases. Surgical removal of the tumor from the spinal canal was technically difficult. A high risk of recurrence has been reported but in these three cases adjunctive radiotherapy appeared to be of benefit in controlling the progression of the disease. These cases, added to the six cases in the literature, confirm the existence of hemangiopericytoma involving the vertebral column with extension into the spinal canal. This entity should be included in the differential diagnosis of lesions of the spinal canal. The risk of intraoperative hemorrhage should be anticipated.

Adult↗