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Biomedical subjects

W G Ward

Publications and source records attributed to W G Ward.

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

Simple, hybrid deep venous thrombosis/pulmonary embolus prophylaxis after total hip arthroplasty.

A 7.1% deep venous thrombosis rate followed total hip arthroplasty in 56 patients using a hybrid prophylactic regimen against deep venous thrombosis and pulmonary embolus. There were no bleeding complications, no symptomatic pulmonary emboli, and no unexplained deaths. The regimen consisted of an initial loading dose of warfarin, usually 10 mg, the night of surgery followed by 2.5 mg/day for 3 weeks, with dosage adjustments only in cases of over-anticoagulation. This regimen was combined with elevated sling suspension of the operative leg, bilateral pedal intermittent pneumatic compression devices, and early mobilization. This prophylactic regimen is simple, inexpensive, efficacious, and compatible with an early hospital discharge.

Arthroplasty, Replacement, Hip↗
PubMed1998

Epithelioid hemangioendothelioma of bone and soft tissue: a fine-needle aspiration biopsy study with histologic and immunohistochemical confirmation.

We retrospectively reviewed two fine-needle aspiration biopsy (FNAB) specimens from two patients with histologically confirmed epithelioid hemangioendothelioma (EH). Both patients were men, ages 79 and 39 years; their primary tumors arose in the soft tissues of the mediastinum and within the proximal tibia, respectively. The former patient had symptoms of superior vena cava syndrome; multicentric intraosseous lesions involved the proximal tibia of the latter patient. All cytologic smears were hypercellular and composed of mostly disassociated single cells and small aggregates of ovoid to polygonal-shaped epithelioid cells. Nuclei were variable, ranging from ovoid and reniform to round and polylobated and surrounded by an abundant amount of dense cytoplasm. Binucleated epithelioid neoplastic cells were frequent. Nuclear pleomorphism ranged from slight to moderate, and small solitary to multiple nucleoli were identified within the majority of tumor cells. Rare neoplastic cells with a single, sharply demarcated intracytoplasmic vacuole and intranuclear cytoplasmic pseudoinclusions were observed in the smears of one tumor. Metachromatic stromal fragments, probably representing hyalinized chondromyxoid stroma, were seen in the other tumor. Neither case was recognized initially on FNAB as EH. Immunohistochemically, sections from the surgical biopsy specimens of both cases showed diffuse and strong immunopositivity for the endothelial marker CD31. Although the cytomorphology of EH appears distinct, clinicoradiologic correlation is essential, and immunohistochemistry may be helpful to avoid misdiagnoses.

Adult↗
PubMed1998

Fine-needle aspiration biopsy of skeletal versus extraskeletal osteosarcoma.

BACKGROUND: Although fine-needle aspiration biopsy (FNAB) of primary skeletal osteosarcoma (OS) has been described adequately, to the authors' knowledge, cytologic descriptions of extraskeletal OS appear limited to only rare case reports. METHODS: In an attempt to analyze the utility and accuracy of FNAB in a diagnosis of skeletal versus extraskeletal OS, the authors retrospectively reviewed their 5-year experience. The study sample included 15 skeletal OS specimens (13 primary, 1 local recurrence, and 1 pulmonary metastasis) in 14 patients ages 10-58 years (mean, 27 years; median, 25 years) and 5 extraskeletal OS specimens (3 primary and 2 metastatic) in 4 patients ages 36, 37, 65, and 79 years, respectively. Based on accepted clinical criteria, two patients (a mother with extraskeletal OS and a daughter with skeletal OS) had Li-Fraumeni syndrome. RESULTS: Of the adequate primary skeletal OS cases analyzed by FNAB, 10 of 12 (83%) were diagnosed correctly and subsequently treated according to a disease specific protocol. One case was considered unsatisfactory. One tumor initially was diagnosed as a giant cell tumor and another was referred to nonspecifically as "spindle-cell neoplasm." On histologic examination, the former case demonstrated a high grade fibroblastic OS arising within a giant cell tumor. None of the primary extraskeletal OS cases analyzed by FNAB was recognized as OS. One was diagnosed nonspecifically as "sarcoma" and the other was referred to simply as "atypical mesenchymal cells." A third case was comprised of scant fragments of adipose tissue, fibrous tissue, and cartilage and was considered unsatisfactory. Both examples of metastatic extraskeletal OS were recognized by FNAB. CONCLUSIONS: With appropriate clinicoradiologic correlation, skeletal OS generally is easily diagnosed by FNAB. Because of the older age of most patients with extraskeletal OS and the rather nonspecific radiographic findings (e.g., soft tissue mass), extraskeletal OS may not be recognized easily by FNAB and most likely requires incisional biopsy to establish a definitive diagnosis in most cases. Additional larger series will be required before drawing definite conclusions.

Adolescent↗
PubMed1998

Skin ulceration from tibial cement extrusion: case report and literature review.

Polymethyl methacrylate extrusion through a small tibial defect occurred during revision of a long-stemmed total knee arthroplasty. It caused necrosis and ulceration of the overlying skin. Resection of the protruding cement, debridement of the ulcer, and primary closure effected a cure. This is the first report of cement-induced skin necrosis and first report of tibial cement extrusion during revision of a total knee arthroplasty. Subcutaneous cement extrusion should be considered in the differential diagnosis of pretibial ulcers following total knee arthroplasty with cemented stems.

Aged↗
PubMed1998

The role of fine-needle aspiration biopsy in the initial diagnosis of pediatric bone and soft tissue tumors: an institutional experience.

The use of fine-needle aspiration biopsy (FNAB) in the initial evaluation of pediatric bone and soft tissue tumors is controversial, especially for those patients being considered for histiogenetic-specific therapeutic protocols, e.g., the Intergroup Rhabdomyosarcoma Study Group, the Pediatric Oncology Group. We retrospectively reviewed 33 consecutive FNAB specimens (28 primary tumors, 5 metastases) from 32 pediatric patients (< or = 19 yr of age), none of whom had a previously established tumor diagnosis. In one patient, FNAB of the primary tumor and a presumed axillary metastasis were obtained concomitantly. The cytomorphologic analysis included osteosarcoma, eight patients; rhabdomyosarcoma, five; neuroblastoma, five; Ewing's sarcoma/primitive neuroectodermal tumor, four; Langerhans' cell histiocytosis, three; and one each synovial sarcoma, undifferentiated sarcoma, infantile myofibromatosis, fibroma, chondroblastoma, chondromyxoid fibroma, and desmoplastic small round-cell tumor. Ancillary studies, e.g., immunocytochemical analysis, were used in 13 cases. Cytogenetic analysis helped to confirm one Ewing's sarcoma [t (11;22) (q24;q12)] and one synovial sarcoma [t(X;18) (p11;q11)]. With adequate FNAB specimens, a histogenetic-specific diagnosis was rendered in 27 (93%) of 29 cases, and all were correctly recognized as either benign or malignant. One case each of Langerhans' cell histiocytosis, chondroblastoma, and infantile myofibromatosis yielded unsatisfactory specimens. Fibroma and desmoplastic small round-cell tumor were initially misclassified as nodular fasciitis and rhabdomyosarcoma, respectively. Of 18 patients clinically eligible for histogenetic-specific therapy protocols, an accurate diagnosis was obtained in 17 patients. With a multidisciplinary approach and judicious use of ancillary studies, FNAB represents a highly accurate and cost-effective technique for the diagnosis of pediatric bone and soft tissue tumors, especially sarcomas, and should be considered as a viable diagnostic technique for pediatric therapeutic protocols.

Adolescent↗
PubMed1997

Chondroblastoma of bone: use of fine-needle aspiration biopsy and potential diagnostic pitfalls.

Chondroblastoma of bone is a well-characterized entity. When the radiographic features are classic and the lesion is present in typical locations (i.e., epiphysis of a long bone), the diagnosis is often easily established by fine-needle aspiration biopsy and/or surgical curettage. Tumors in unusual locations, in older patients, or when complicated by aneurysmal bone cysts may pose more diagnostic difficulty. We report four examples (three primary and one-recurrent) of chondroblastoma of bone diagnosed by fine-needle aspiration biopsy. All patients were men, ranging from 18 to 28 yr of age. Sites of involvement included the acromion process of the scapula, left humerus, right ischium, and left distal femur. Three of the tumors were diagnosed as chondroblastoma on fine-needle aspiration cytology; the fourth case, involving the scapula, consisted mostly of a large aneurysmal bone cyst and remained unrecognized until surgical curettage was performed. Typical-appearing chondroblasts were present in three of the cases; osteoclast-type giant cells were observed in all four cases. Matrix material consistent with chondroid was also identified in all cases. We believe that in the absence of inflammatory cells, the presence of classic-appearing chondroblasts, even without chondroid matrix, is sufficient for a diagnosis of chondroblastoma of bone.

Adolescent↗
PubMed1997

Fine-needle aspiration biopsy of gouty tophi: lessons in cost-effective patient management.

Gout, a disease resulting from the effects of hyperuricemia and a crystal-induced arthropathy, may produce soft tissue masses (tophi) which mimick neoplasia clinically and radiographically. We have recently diagnosed three cases of gouty tophus, two of which were clinically suspected to represent sarcomas, by fine-needle aspiration biopsy (FNAB) after extensive radiologic and clinical evaluation. There were two women and one man. aged 71, 73, and 50 yr, with palpable soft tissue masses that involved the right forearm, right hand, and right foot, respectively, Biopsies were obtained by using 25-gauge needles without the aid of general anesthesia. Morphologically, aggregates and disassociated slender, needle-shaped crystals were abundant and easily recognized on both Diff-Quik and Papanicolaou stains. By using a polarizing microscope with a first-order red compensator, the crystals showed negative birefringence, characteristic of sodium urate. Benign-appearing histiocytes, foreign-body-type giant cells, neutrophils, and amorphous debris were scattered among the diagnostic crystals. The diagnosis of gouty tophus can be easily established with FNAB in conjunction with compensated polarizing microscopy. Application of FNAB in the initial evaluation of appropriate soft-tissue masses provides a cost-effective diagnostic method, preventing more costly and often unnecessary clinical and radiologic tests.

Aged↗
PubMed1997

Malignant peripheral nerve sheath tumor: a fine-needle aspiration biopsy study.

Although the histopathologic features of malignant peripheral nerve sheath tumors (MPNST) have been well-described, the cytologic features are less well-characterized. We retrospectively reviewed 4 aspiration specimens from 3 patients with histologically-proven MPNST. The biopsy specimens were obtained from the primary tumor (1 case), a local recurrence (2 cases), and a pulmonary metastasis (1 case). The patients were women, aged 42, 61, and 70 yr. The primary tumors arose from the left neck and elbow, and from a neurofibroma in the right medial thigh. The latter patient had von Recklinghausen's disease. Cardinal cytomorphologic features included aggregates and single cells with ovoid to elongated, and comma to serpentine shapes, as well as hyperchromatic nuclei surrounded by delicate, tapering cytoplasm. Nuclear pleomorphism ranged from slight to marked. Multinucleated giant cells were seen in 2 cases. In general, the degree of nuclear variability within each individual case exceeded that typically observed with synovial sarcoma or fibrosarcoma. Although the cytomorphologic features may strongly suggest MPNST, clinical correlation is necessary and immunocytochemistry (i.e., S-100 protein) may help to distinguish MPNST from other spindle-cell sarcomas. Origin from a nerve trunk or preexisting neurofibroma, or occurrence in a patient with von Recklinghausen's disease, confirms the diagnosis of MPNST.

Adult↗
PubMed1997

Dedifferentiated chondrosarcoma in patients with multiple osteochondromatosis: report of a case and review of the literature.

Multiple osteochondromatosis (MOS) is a familial disorder of autosomal dominant transmission characterized by the development of multiple exostoses and often derangements of epiphyseal cartilage, sometimes resulting in long bone growth retardation. Patients with the disorder appear to be at increased risk for developing secondary chondrosarcomas. Rarely, dedifferentiated chondrosarcomas may also occur. We report a single case of a 27-year-old man with multiple osteochondromatosis who developed a fatal dedifferentiated chondrosarcoma. Radiographically, the neoplasm arose from the pelvis completely destroying the left pubic ramus. Subsequently, the patient underwent preoperative chemotherapy followed by a left external hemipelvectomy. On pathologic examination, the tumor was characterized by high-grade pleomorphic sarcoma sharply juxtaposed to a low-grade chondrosarcoma. The patient ultimately died of widespread metastatic sarcoma.

Adult↗
PubMed1997

Loosening of massive proximal femoral cemented endoprostheses. Radiographic evidence of loosening mechanism.

A review of the radiographs of 24 patients with massive proximal femoral cemented tumor endoprostheses revealed a repetitive radiographic sequence that culminated in implant loosening. The initial step was osteolysis of the proximal femur at the bone-prosthesis junction (13 of 24 cases, 54%). The osteolysis then progressed into the adjacent periprosthetic bone-cement interface as a radiolucent line (5 of 24 cases, 21%), followed by extension along the stem, culminating in implant loosening (4 of 24 cases, 17%). Two prostheses (8%) have required revision for loosening. The proximal osteolysis was noted prior to the appearance of progressive periprosthetic radiolucent lines in 11 patients and simultaneously in 2 but never followed periprosthetic radiolucent lines (P < .05). These findings are consistent with loosening by debris-induced osteolysis. This loosening sequence, confirming previous observations of cemented component loosening, should encourage efforts to prevent or delay the onset of this sequence.

Adolescent↗
PubMed1997

Antibiotic prophylaxis and infection resistance of massive tumor endoprostheses during chemotherapy.

Fifty-five consecutively treated patients with malignant bone tumors had preoperative and postoperative chemotherapy by one oncologist. These same patients had massive bone resection and cemented endoprosthetic bone replacement by one orthopaedic oncologist. Despite 143 instances of documented fever and/or neutropenia in 45 of these 55 patients, no known deep periprosthetic infections developed in any patient during follow-up (mean, 29.4 months; median, 25 months; range, 5 months to 62 months). Broad spectrum antibiotics had been administered in at least 118 instances to these patients (intravenously in hospital, 9 times to 7 patients; intravenously at home, 38 times to 18 patients; and orally at home, 71 times to 26 patients). This study confirms the low infection rate of these massive endoprostheses, despite neutropenic and/or febrile episodes if the patient is given prophylactic broad spectrum antibiotics during the episodes. We support the continued use of massive endoprostheses for bone reconstruction in patients requiring chemotherapy.

Adolescent↗
PubMed1996

Fine-needle aspiration biopsy of synovial sarcoma. A cytomorphologic analysis of primary, recurrent, and metastatic tumors.

Thirteen fine-needle aspiration specimens from 10 patients with histologically proven synovial sarcoma are described. The aspiration biopsy specimens were obtained from the primary tumor in five cases, locally recurrent tumors in four cases, pulmonary metastases in three cases, and mediastinal metastasis in one case. Patient's ages ranged from 22 years to 65 years; there were four women and six men. All cases had a confirmation biopsy and/or resection specimen that were reviewed. Histologic subtypes included monophasic fibrous (5 cases), monophasic epithelial (1 case), biphasic (3 cases), and poorly differentiated (1 case). The majority of the aspiration biopsy specimens were similar with moderate to marked smear cellularity dominated by cohesive clusters of spindle-shaped cells with ovoid, hyperchromatic nuclei and scanty tapering cytoplasm. Nucleoli were not prominent. Epithelial tumor cells with ovoid to round, mostly regular, centrally to eccentrically located nuclei, surrounded by scant to abundant cytoplasm predominated in one case (monophasic epithelial) and were admixed with spindle cells in a second (classical biphasic). Multi-nucleated tumor giant cells were not observed in any of the tumors. In biphasic synovial sarcoma, the neoplastic spindle cells are generally more numerous and frequent than the epithelial cells, making distinction from monophasic synovial sarcoma or other spindle cell soft tissue tumors difficult. Although synovial sarcoma may be diagnosed by fine-needle aspiration cytology, clinical correlation, especially in monophasic types, is necessary to minimize errors in sarcoma classification.

Adult↗
PubMed1996

Endoprosthetic bone reconstruction following malignant tumor resection in skeletally immature patients.

Modular and expandable endoprosthetic reconstruction of the child's extremity following bone tumor resection affords an opportunity for both limb salvage and progressive limb length equalization. This article discusses the rationale, advantages, disadvantages, and results of endoprosthetic bone reconstruction following tumor resections in the skeletally immature patient. In addition to an extensive literature review, an overview of the authors' results with this reconstructive option in 31 patients over the past 14 years is presented. This article will inform the reader of the current state of the art in endoprosthetic reconstruction of the immature patient and should allow clinicians to make more informed decisions regarding treatment options for their patients.

Bone Neoplasms↗
PubMed1995

Growth factor expression in skin during wool follicle development.

A variety of growth factors are likely to be involved in initiation and morphogenesis of wool follicles. To enable direct comparisons of the expression of different growth factors, reverse transcriptase-polymerase chain reactions (RT-PCR) were developed for ovine and murine TGF alpha, TGF beta 1, TGF beta 2, TGF beta 3, IGF1, IGF2, and FGF-2, which could all be carried out on a single cDNA sample. These RT-PCR were used with 16 sheep RNA samples from different foetal stages, neonatal sheep and mouse skin. The mRNAs for these growth factors were detected throughout gestation in sheep skin, except for TGF beta 1 mRNA which was not expressed in 51-day-old skin, but was expressed in 54-day and older samples. Since the first microscopically visible changes of follicle initiation occur around 62 days gestation, these results suggest that TGF beta 1 expression may be a signal for follicle initiation.

Animals↗
PubMed1995

Atypical and malignant variants of ossifying fibromyxoid tumor. Clinicopathologic analysis of six cases.

Ossifying fibromyxoid tumor (OFMT) of soft parts is a recently defined fibro-osseous neoplasm, the biologic behavior of which is generally regarded as benign. We report six variant cases of OFMT with histologic features of malignancy, two of which behaved aggressively. All these tumors arose in the extremities of adults (aged 36-76 years), and five of the six were subcutaneous. Four patients were men. Macroscopically, all the tumors were well circumscribed and somewhat lobulated. Cardinal morphologic features included lobules of round to spindled cells within a fibromyxoid matrix and randomly distributed, often centrally located osteoid within which were plump neoplastic cells. In contrast to typical OFMT, a hypocellular, cytologically benign, lamellar bony shell was observed only focally; cellularity was increased (four cases), and mitotic activity was frequent, exceeding two mitotic figures per 10 high-power fields (three cases). One case associated with metastases was morphologically bland. Immunohistochemically, positivity for S-100 protein was observed in the primary tumors of three cases and in the pulmonary metastasis of a fourth. Desmin was positive in one case. Ultrastructural features in three cases were very similar to usual OFMT. Clinical follow-up revealed local recurrence in two cases; one patient has developed recurrent pulmonary metastases. We believe these findings support the view that some atypical cases of OFMT exhibit morphologic patterns that might predict more aggressive behavior.

Adult↗