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Biomedical subjects

W Mnaymneh

Publications and source records attributed to W Mnaymneh.

At least 19 recordsLinked to original sources
PubMed2000

Internal hemipelvectomy for solitary pelvic thyroid cancer metastases.

BACKGROUND AND OBJECTIVES: Radioactive iodine (RAI) therapy remains a primary treatment modality for metastatic thyroid carcinoma, but poor tumor uptake of the agent can limit its usefulness. While offering effective palliation, radiation therapy is not curative, and chemotherapy is even less useful. Surgical resection occasionally remains the only hope of offering a long-term cure in the case of isolated metastases. METHODS: We describe 3 cases of thyroid cancer metastatic to the pelvic girdle that were unresponsive to RAI and other nonoperative therapies, which presented over a 15-year time period. The pelvic disease was the only site of active disease in all cases, and all 3 patients were suffering considerable pain. All 3 patients underwent internal hemipelvectomy with reconstruction in 2 cases using a pelvic bone allograft. RESULTS: All 3 experienced symptomatic relief and early mobilization. While the infection rate was 100%, these all responded completely to operative debridement, irrigation, and antibiotics. One patient, found postoperatively to have a positive surgical margin, developed a local recurrence at 4 months and died. A second patient developed a local recurrence at 11 months and died. The third patient underwent a revision of her hip arthroplasty because of acetabular loosening after a fall 21 months postoperatively. She is alive, disease-free, and ambulatory with the aid of a cane 32 months after the original procedure. CONCLUSIONS: We propose this surgical procedure in selected patients with metastatic pelvic thyroid cancer. It provides symptomatic relief with a chance for prolonged disease-free survival some patients.

Acetabulum↗
PubMed1999

Osteoid osteoma. Computed tomography guided percutaneous excision.

The authors' experience with computed tomography guided excision of osteoid osteoma in an outpatient setting using an Einhorn biopsy set and a power drill in 21 patients is described. In the last 5 years, 21 patients aged 7 to 51 years who had radiographic findings and symptoms of osteoid osteoma were included in the study. The nidus of the tumor was excised successfully in all cases using a coaxial technique with a power drill. Excision of the nidus was confirmed by postexcision computed tomography scans, histologic evaluation, and absence of symptoms on clinical and radiographic followup. Only one minor complication and no recurrences occurred with a mean followup of 17 months (range, 9-43 months). Percutaneous computed tomography guided excision is an effective, safe, and cost effective method of treatment of osteoid osteoma.

Adolescent↗
PubMed1998

Does a radiation dose-response relation exist concerning survival of patients who have soft-tissue sarcomas of the extremities? Radiation dose-response relation for soft-tissue sarcomas.

This study analyzes a single-institution experience by evaluating the impact on survival of increasing total dose of adjunctive irradiation in patients who had extremity soft-tissue sarcoma (ESTS). A retrospective review of the tumor registry at a university medical center from January 1984 through December 1992 yielded a total of 59 surgical patients of ESTS. With follow-up ranging from 30 to 135 months (median, 65 months), the 2-, 5-, and 8-year overall and disease-free survival for all patients was 86%, 71%, 58% and 76%, 70%, 56%, respectively. Multivariate analyses using the Cox proportional hazards model revealed that total radiation dose (p = 0.02), American Joint Committee on Cancer stage (p = 0.04), and tumor size (p = 0.006) were all significant prognostic factors of overall survival; however, only tumor size was predictive of disease-free survival (p = 0.02). When the effect of tumor size and disease stage were controlled in the Cox model, a dose-response curve between increasing total radiation dose and improved overall patient survival was indicated. This study demonstrates the significance of tumor size on predicting both overall and disease-free survival in patients who have soft-tissue sarcomas of the extremity. It also suggests, however, that a radiation dose-response relation may exist for overall survival. Future investigations should consider evaluating the minimal total radiation dose needed to optimize patient survival after limb-sparing surgery.

Adolescent↗
PubMed1998

Limb salvage with osteoarticular allografts after resection of proximal tibia bone tumors.

A retrospective study was performed between 1980 and 1995 on 38 recipients of proximal tibial allografts after wide resection of benign and malignant tumors. Twenty-one (55%) patients experienced one or more complications. Of the 26 patients who received chemotherapy, 15 (58%) experienced one or more complications, whereas of the 12 patients who did not receive chemotherapy, six (50%) experienced one or more complications. In the chemotherapy group, there were 12 (46%) fractures, four (15%) infections, three (12%) nonunions, and four (15%) instabilities. In the nonchemotherapy group there were three (25%) infections, two (17%) fractures, one (8%) instability, and one (8%) nonunion. These complications were managed adequately with multiple subsequent surgical procedures. Three patients underwent amputations for deep wound infections. Twelve (32%) patients underwent removal of the allograft, and the limb was salvaged by reallografting or by total knee arthroplasty. The results of both groups were 66% (25 of 38 patients) satisfactory (good or excellent). The chemotherapy group had a significantly higher incidence of fractures. All other complication rates and functional outcomes were not significantly different between these groups.

Adult↗
PubMed1996

Hemorrhagic prepatellar bursitis.

Simple prepatellar bursitis is easily diagnosed both clinically and by MRI. MRI shows the typical T1 and T2 lengthening of fluid within the bursa. However, because of complex MRI appearance of hemorrhage, chronic hemorrhagic bursitis and the size of the prepatellar mass the clinical and MRI appearance can be very different.

Bursitis↗
PubMed1996

Intraosseous ganglion cyst associated with neuropathy.

We present a case of expansile intraosseous ganglion of the fibular head with cortical breakthrough, which has not been previously reported. Also associated with this case, and not previously reported, is peroneal nerve compression, causing foot drop caused by the large expansile nature of the lesion.

Aged↗
PubMed1994

Massive distal femoral osteoarticular allografts after resection of bone tumors.

Records were reviewed for 96 patients who received distal femoral osteoarticular allografts to reconstruct femurs after wide resections of benign and malignant bone tumors. Thirteen of these were excluded from the study because of death or local recurrence. The mortality rate for all patients was 11%; for those with osteosarcomas it was 27%. The local recurrence rate was 3%. Eighty-three patients were subjected to further analysis. Their complications included fractures (14%), nonunions (12%), arthritis (10%), instability (7%), infections (6%), and resorption (6%). There was a significant difference in nonunion and infection rates between patients who received chemotherapy and those who did not. In the chemotherapy group, the infection rate was 13% versus 2% in the non-chemotherapy group. Nonunion rates were 23% versus 6% respectively. The differences in all other complication rates were not statistically significant. In patients not receiving chemotherapy (n = 53), final results were good or excellent in 70%, fair in 26%, and poor in 4%. In patients receiving chemotherapy (n = 30), final results were good or excellent in 53%, fair in 37%, and poor in 10%.

Adolescent↗
PubMed1994

Cryopreservation of articular cartilage. Ultrastructural observations and long-term results of experimental distal femoral transplantation.

Ultrastructural changes associated with the freeze-preservation of human articular cartilage have been investigated and related to changes in transplanted distal femoral allografts in nonhuman primates. Human osteoarticular specimens were frozen at 2 degrees/minute in the presence of 15% glycerol and kept in liquid nitrogen freezers (vapor phase) from one day to two years. Ultrastructural changes were confined primarily to chondrocytes and were related to the freezing phenomenon, not to the time of storage. The cartilage matrix was affected little, explaining why articular cartilage initially survives clinical transplantation, but later undergoes degenerative changes. Osteoarticular allografts of baboons were frozen in an identical fashion to the human articular cartilage and transplanted into adult baboons. Long-term observations (five years) on these animals showed healing and replacement of the osseous portion of cryopreserved allografts. Fractures that appeared to coincide with maximum revascularization of the graft were the principal complication. Articular surfaces of the cryopreserved allografts underwent degenerative changes over five years. These degenerative changes were also manifested radiologically and appeared similar to those observed in humans. By contrast, fresh osteoarticular allografts healed poorly through fibrous union. However, in one of two fresh allografts, the articular cartilage remained intact five years after transplantation.

Adolescent↗
PubMed1991

Scapular allografts. A report of two cases.

Some malignant tumors of the scapula can be adequately treated by limb-sparing, partial, or total scapulectomy. However, resection of the glenoid portion of the scapula and total scapulectomy result in an unsightly shoulder. In an attempt to minimize the functional impairment and restore stability and cosmesis, scapular glenoid allografts offer a reasonably good biologic replacement. This report describes the cases of a 45-year-old woman and a 32-year-old man in whom massive osteoarticular allografts were used. In one patient, good stability, cosmesis, and function were restored after resection of the glenoid portion. In the other patient, shoulder stability, cosmesis, and limited function were restored after total scapulectomy. No reports of scapular allografts seem to have been previously published in the literature.

Adult↗
PubMed1990

Massive allografts in salvage revisions of failed total knee arthroplasties.

Ten patients with failed total knee arthroplasties and severe bone loss were treated with massive whole distal femur and proximal tibial allografts in combination with prosthetic implants. Fourteen allografts were inserted either as invaginated or segmental grafts and were rigidly fixed to the host bone. Clinically and roentgenographically, 12 of 14 grafts (86%) seemed to have united to the host bone. The average range of motion was 92 degrees. Five patients developed complications; two of these involved the allograft (nonunion and fracture) and two were caused by inadequate healing at the ligament-allograft junction. One patient had a late infection. With careful planning and improved surgical techniques, these complications can be avoided. The massive allograft-prosthesis composite techniques is a viable reconstructive alternative worthy of further clinical trials.

Aged↗
PubMed1990

Pelvic allograft. A case report with a follow-up evaluation of 5.5 years.

A 23-year-old man with a large chondrosarcoma of the right bony pelvis was successfully treated by limb-saving internal hemipelvectomy and anatomic reconstruction of the pelvis by a pelvic osteoarticular allograft including the acetabulum. Optimum anatomic fit was achieved at the hip joint as well as at the iliac and pubic host-graft junctions, which were fixed with plates and screws. This reconstruction restored stability, leg length, hip motion, and cosmesis. Five and one-half years postoperatively, the patient remained asymptomatic with good functional and roentgenographic results.

Adult↗
PubMed1989

Malignant giant cell tumor of soft parts presenting as a skin tumor.

Malignant giant cell tumor of soft parts is a rare neoplasm that histologically resembles a giant cell tumor of bone. It has a distinctive multinodular growth pattern and is composed of numerous osteoclast-like giant cells, histiocytes, and fibroblasts. Although this tumor is usually found in deep soft tissues, a superficial form has been described in the subcutaneous tissue and fascia. The authors report two patients, aged 75 and 78, with malignant giant cell tumors presenting as ulcerating skin nodules of the arm and foot. The tumors were relatively small, measuring less than 3.5 cm in greatest dimension, and involved the entire dermis and subcutaneous tissue. The clinical differential diagnoses included Kaposi's sarcoma, melanoma, and hematoma. Dermatopathologists and dermatologists should be aware of this entity to avoid confusion with other benign and malignant neoplasms that may contain multinucleated giant cells. The distinguishing histologic and immunohistochemical features of this tumor are discussed.

Aged↗
PubMed1989

Massive allografts in surgery of bone tumors.

Large osseous and osteoarticular allografts have provided the orthopedic oncologist with a useful biological reconstructive alternative following wide en-bloc resection of bone tumors. Although the surgical procedures are complex, meticulous surgical techniques in terms of graft selection, allograft fixation, reconstruction of joint ligaments and tendons, and adequate skin coverage would produce satisfactory results in about three quarters of the patients. The potential causes of failure include allograft fracture, infection, nonunion and joint instability.

Adult↗
PubMed1988

Hemangiosarcoma of the left foot and tibia: case report.

A case of a hemangiosarcoma involving the bones of the foot in a diabetic patient who had swelling of the left foot is reported. Radiographs demonstrated multiple lytic areas throughout the bones of the foot. Clinically and radiographically, infection was suspected, but the biopsy revealed the presence of tumor. Metastases to the tibia were found and an above the knee amputation was performed. Chemotherapy was given, but 6 months later the patient died. Hemangiosarcoma is known to involve the different bones of the foot in a "multicentric" fashion and should be considered in the differential diagnosis of lytic lesions of multiple bones of the lower extremities.

Bone Neoplasms↗
PubMed1988

Computed tomography evaluation of stability in posterior fracture dislocation of the hip.

Measurements of the percentage of remaining posterior acetabulum on computed tomography (CT) scan (the Acetabular Fracture Index) in posterior fracture dislocations of the hip were evaluated to determine the stability of the joint. All hips with less than 34% of the remaining posterior acetabulum were unstable. Hips with greater than 55% were stable. Between these values, hips were either stable or unstable. A statistical analysis demonstrated highly significant differences in the average remaining posterior acetabulum between the stable and unstable group. These findings were based on a review of 26 patients with posterior fracture dislocations of the hip (Epstein Type I-IV injuries) combined with CT scan analysis. The clinical status of hip stability was correlated with the Acetabular Fracture Index, and this provided the basis for the study. A simple linear measurement of the remaining posterior acetabulum on CT (the Approximate Acetabular Fracture Index) can be done easily by a physician, and this closely approximates the true remaining acetabular arc. Seven of ten unstable hips in 31 Epstein Type I-V patients showed femoral head subluxation of 0.5 mm or more on CT scan, whereas none of the 21 stable hips had demonstrable subluxation. Risk analysis provided a means of predicting hip stability for individual patients.

Acetabulum↗