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PubMed2005

Blood loss and transfusion associated with musculoskeletal tumor surgery.

BACKGROUND AND OBJECTIVES: No organized data regarding the blood losses associated with musculoskeletal tumor surgery has been existed. The present study aimed to examine the extent of blood loss and the transfusion requirement associated with various kinds of musculoskeletal tumor surgeries in a large, well-defined sample. METHODS: The records of 1,047 consecutive operations for musculoskeletal tumors were reviewed. RESULTS: The total blood loss ranged from 0 to 26,050 ml (median: 95 ml). The operative time ranged from 5 to 1,140 min (median: 105 min). There was a significant correlation between the total blood loss and the operative time. The median blood loss was 10 ml in biopsies, 100 ml in curettages, 190 ml in amputations or disarticulations, 30 ml in marginal resections (bone tumors, 50 ml; soft tissue tumors, 25 ml), and 380 ml in wide resections (bone tumors, 2,155 ml; soft tissue tumors, 180 ml). Wide resections for malignant tumors were associated with significantly more blood loss than marginal resections for benign ones. Resections of bone tumors were accompanied by significantly more blood loss than those of soft tissue tumors. Overall, blood transfusions were required after 210 (20.1%) operations. CONCLUSIONS: Our results provide the first exhaustive data about blood loss and the subsequent need for transfusion associated with various kinds of musculoskeletal tumor surgeries that may be helpful for establishing a guideline for perioperative patient management.

Adolescent↗
PubMed1984

Ewing sarcoma of the hand: literature review and a case report of nonsurgical management.

A case of a 12-year-old girl with Ewing sarcoma of the third metacarpal bone is described. Following an incisional biopsy, radiation therapy and adjuvant chemotherapy were given. The girl is now 34 months postdiagnosis and 25 months off therapy in sustained complete remission and functionally normal right hand. Of the seven previously published cases only two are long-term survivors (one had disarticulation, and the other resection of the fourth and fifth rays).

Adolescent↗
PubMed1985

Hemangiosarcoma complicating Paget's disease of the bone.

An 87-year-old man with Paget's disease of the left humerus was found to have a Paget's sarcoma upon pathologic examination of the left upper limb, which was disarticulated for severe pain and recurrent fractures. The histologic type of this tumor, a hemangiosarcoma, was unique among Paget's sarcomas.

Aged↗
PubMed1991

Major amputations done with palliative intent in the treatment of local bony complications associated with advanced cancer.

Palliative amputations were performed on 11 patients (7 men, 4 women) with disseminated disease to control local bony complications. The average patient age was 54 years (range 14-78 years). The primary diseases were melanoma/sarcoma (seven patients) and carcinoma (four patients). All had pain; eight had intractable pain that could not be controlled by analgesics. All 11 patients had additional severe local complications, which included recurrent pathological fracture (4), sepsis (2), hemorrhage (2), radiation necrosis (2), and iliofemoral thrombosis secondary to tumor (1). Previous attempts of palliation had been made in all 11 patients, and 8 had undergone previous operative procedures (5 had undergone two or more) prior to amputation. Three anterior hemipelvectomies, five posterior hemipelvectomies, two hip disarticulations, and one forequarter amputation were performed. All patients survived the surgery, and there were no intraoperative complications. All patients received dramatic relief of pain. Postoperative complications included two cases of flap necrosis and two infections; all resolved satisfactorily. The six patients who were nonambulatory before surgery ambulated postoperatively, and two eventually ambulated with a prosthesis. Six of 11 patients survived 1 year or longer, with a median postoperative survival period of 13 months (average 16 months). Although major amputations are viewed at times as offering little to already-compromised patients, they can improve dramatically the quality of life in selected patients.

Adolescent↗
PubMed1991

A myocutaneous flap for closure of upper arm amputations for uncontrolled axillary tumors.

Tumor spread or recurrence in the axilla is usually treated with nodal dissections. At times disease recurrence is uncontrolled, causing significant morbidity including pain, bleeding, lymphedema, and neurologic symptoms. Previously, forequarter amputation has been the treatment for this problem, resulting in a significant cosmetic and functional deficit. This report describes a novel myocutaneous flap that can be used to cover soft tissue defects after major disarticulations of the upper extremity. The deltoid myocutaneous flap has been used to successfully treat three patients with uncontrolled tumors in the axilla and preserve the shoulder structures to lessen the functional deficit.

Amputation, Surgical↗
PubMed1995

Ewing's sarcoma of bone: oncologic and functional results.

This paper describes 29 patients with Ewing's sarcoma of bone treated between 1975 and 1990 at the University of Nijmegen Hospital, Nijmegen, The Netherlands. Osteomyelitis was the primary diagnosis in 24%. Treatment consisted of chemotherapy in combination with surgery and/or radiotherapy. Nine patients received radiotherapy only; five of them died of disease. Five patients underwent an intralesional excision; four of them died of disease. Twelve patients underwent a wide excision; there is no evidence of disease in any of them. Three patients underwent a radical disarticulation; all died of disease. The disease-free survival at 1.5 years was 66%. This figure at 5 years was 55%. After wide excision and reconstruction in tumors of expendable, femoral or radial bones good functional results were obtained in all cases.

Adolescent↗
PubMed1995

Recurrent endometrial adenocarcinoma presenting as a solitary humeral metastasis.

A 66-year-old woman was admitted because of postmenopausal vaginal bleeding. Diagnostic workup revealed a poorly differentiated endometrial adenocarcinoma. A total abdominal hysterectomy and bilateral salpingo-oophorectomy was carried out (FIGO stage Ia, G3). One and a half years later she developed a solitary humeral metastasis which was treated by local radiotherapy and progesterone acetate. Because osseous metastases in endometrial adenocarcinoma are rare, the literature is reviewed. In analogy to the treatment of pulmonary metastases the option of disarticulation of the patient's arm is discussed.

Adenocarcinoma↗
PubMedDate not supplied

Carnivoran paleoguilds of Africa: implications for hominid food procurement strategies.

Tool-using hominids, as carnivorous animals, would have been part of the various carnivore guilds present in Plio-Pleistocene Africa. Hominid dietary strategies must be understood within the larger context of carnivore behavior and ecology, as carnivorans could have affected the abilities of hominids to procure meat and/or marrow. The functional anatomy of extant and fossil carnivorans was examined to infer behaviors in fossil carnivorans that would have impacted on hominid dietary strategies in terms of carcass availability. Comparisons of guild structure were carried out to examine changes in carnivoran interactions and their implications for hominid behavior. Plio-Pleistocene carnivorans engaged in a wider range of behaviors than modern carnivorans. The sabertoothed felids Dinofelis and Megantereon probably did not provide much larger carcasses than modern species. Another sabertooth, Homotherium generated larger carcasses, but may have disarticulated and transported these carcasses. Fossil representatives of modern taxa may not have been equivalent ecologically within the carnivoran guild. Overall, hominids in eastern Africa probably had a greater range of scavenging opportunities than did those of southern Africa during the Plio-Pleistocene. Local and continent-wide extinction events in large-bodied carnivoran guilds from 1 to 2 Ma had a substantial effect on carcass availability and the risk to hominid scavengers. These structural changes in the carnivore guild may have provided an opportunity for hominids to widen their niche with respect to dietary behavior.

Africa↗
PubMed1999

Middle Palaeolithic burial is not a dead issue: the view from Qafzeh, Saint-Césaire, Kebara, Amud, and Dederiyeh.

Inferences of purposeful Middle Palaeolithic (MP) burial are almost universally accepted, despite published arguments that the pre-1960s discoveries are equally well explained by natural processes. In the modern human origins debate (perhaps the most hotly disputed question in palaeoanthropology) inferences of MP burial are crucial in arguments for an early Upper Pleistocene emergence of modern humans. The present paper contributed to that debate by re-examining a number of post-1960s excavations of MP hominid remains. Because these were excavated with meticulous attention to depositional circumstances and stratigraphic context, most palaeoanthropologists consider these inferences of purposeful burial to be based on irrefutable evidence. This paper focuses on the reasoning behind such claims, especially the assumption that articulated sketetal material is prima facie evidence for deliberate burial. First it reviews a range of processes operating in caves and rockshelters that condition the probability of articulated skeletal material preserving without hominid intervention. Processes such as deposition, decomposition, and disturbance are inherently more variable in caves and rockshelters than is usually acknowledged. The first section concludes that purposeful protection is not necessary to account for the preservation of articulated skeletal remains. The second part of the paper examines the published record from Qafzeh, Saint-Césaire, Kebara, Amud and Dederiyeh, where the majority of the remains claimed to have been buried are fragmented, incomplete, and disarticulated. This re-examination suggests that in all of the post-1960s cases of putative burial, the hominid remains occur in special depositional circumstances, which by themselves are sufficient to account for the preservation in evidence at these sites. This conclusion severely weakens arguments for purposeful burial at the five sites. Moreover, the equivocal nature of the evidence in the more recent cases renders even less secure the similar claims made for discoveries of hominid skeletal remains at La Chapelle-aux-Saints, Le Mousterier, La Ferrassie, Teshik-Tash, La Grotte du Régourdou, Shanidar, and several others. Finally, by highlighting the equivocal nature of the evidence, this paper underscores the ongoing need for palaeoanthropologists to specify as wide a range of taphonomic processes as possible when interpreting the archaeological record. This will aid in producing robust inferences, and will bring about increasingly accurate knowledge of when hominids became human.

Animals↗
PubMed1999

Duinefontein 2: an Acheulean site in the Western Cape Province of South Africa.

Excavations at Duinefontein (DFT) 2 near Cape Town, South Africa have recovered numerous stone artefacts and animal bones on an ancient surface sealed within iron-stained eolian sands. U-series analysis of an overlying calcrete places the sands before 150 ka ago, while the large mammal taxa imply an age between 400 and 200 ka ago. The artefacts include a classic Acheulean handaxe and probable biface shaping flakes that support this age estimate. The principal mammalian species are long-horned buffalo, black wildebeest, greater kudu, Cape zebra, and grysbok/steenbok, which imply a grass-and-bush mosaic instead of the historic small-leafed shrubland. Hippopotamus and reedbuck indicate that water stood nearby, probably in dune swales. The large mammal bones are mostly vertebrae and other axial elements, often in near-anatomical order. Both proximal and distal appendicular elements are rare. Bones with carnivore damage are common, but ones with stone tool marks are scarce. The sum suggests a water-edge attritional death site where people played a minimal role and carcasses were disarticulated mainly by carnivore feeding and by trampling. Stone tool marks tend to be equally rare at other Acheulean attritional death sites, and the implication may be that Acheulean people rarely obtained large mammals, whether by hunting or scavenging. Human scavengers at DFT2 would not have encountered a disproportionate number of distal (versus proximal) limb elements, and it follows that the tendency for distal elements to dominate many archeological assemblages need not reflect scavenging versus hunting. Even if DFT2 was not itself a locus of intense human activity, it provides a useful baseline for evaluating bone damage, skeletal part representation, and other variables at sites where people were deeply involved.

Animals↗
PubMed1994

Late complications after total hip replacement in renal allograft recipients.

Seventy nine hips in 53 recipients of renal allografts were treated by cemented total hip replacement for avascular necrosis of the femoral head between 1972 and 1992. Eight hips in 6 patients required revision for aseptic loosening after a mean of 11.2 years. Three replacements in 3 patients became infected with salmonella enteritidis after a mean of 6.2 years. One was revised, one had a disarticulation of the hip, and the third was treated with long term antibiotics. Survivorship analysis for total hip replacement and the renal allografts showed a hip reoperation rate of 9.9% at 10 years and 54.6% at 15 years with mortality rates of 32.2% and 42.2% respectively. Thus patients surviving 15 years are at a higher risk of failure of the prostheses than of dying.

Adult↗
PubMed1991

Complications of suppurative arthritis and osteomyelitis in children.

Three children with suppurative arthritis and osteomyelitis are described to emphasise that delayed or incorrect diagnosis may lead to serious cardiopulmonary complications. In two patients, bilateral bronchopneumonia developed with pneumatocoeles, pneumothorax and empyema. The other had cardiac failure from septic pericarditis. In one case, disarticulation of the knee was needed as a life-saving measure, and the other leg developed an infected pseudarthrosis of the tibia. The causative organism in each case was staphylococcus aureus and no evidence of immunodeficiency was demonstrated.

Acute Disease↗
PubMed1992

Scanning electron microscopic evaluation of the arthritis in MRL/lpr mice.

The articular surfaces of disarticulated knee joints from MRL/lpr and MRL/n mice, aged 4-33 weeks were examined by light microscopy (LM) and scanning electron microscopy (SEM). Light microscopy did not reliably predict SEM findings. Most of the abnormalities detected by SEM were related to surface disruption of articular cartilage. However, areas of articular cartilage covered by tightly adherent non-confluent monolayers of stellate-shaped cells with intertwining cytoplasmic processes were observed. In these areas the integrity of the underlying cartilage matrix was disrupted, with exposure of collagen fibers. These findings suggested that outgrowth of proliferating synovial cells in the joints of arthritic MRL/lpr mice may lead to cartilage destruction.

Animals↗
PubMed1975

[Atypical amputations of bone tumors of the lower extremity (author's transl)].

The most predominant problem concerning malignant tumors in the lower extremities is the radical removal of the tumor, for this almost always involves amputation. Referring to the eventual outfitting of a prosthesis one must keep functionality in mind from the start. This includes all the planing for the preservation of a stump that can be fitted with a prosthesis. Experience has confirmed the advantages of foot-root stumps and knee disarticulation. Good functional results can be attained with tumors of the femur in individual cases through atypical operations. This involved elongation of the stump by means of a fibula transplant; replacing the femur with a bioceramic endoprosthesis; and rotation-plasty, whereby the knee joint is replaced by the ankle joint.

Adolescent↗
PubMed1978

Ultrastructural study of microcyclic macroconidiation in Neurospora crassa.

Heat-shock of macroconidia of Neurospora crassa at 46 degrees C followed by shift-down to 25 degrees C determines premature conidiogenesis. The nuclei and cytoplasmof heat-treated, swollen conidia contain spots of a dense material especially concentrated around the nucleolus in short time treated ones. In the first proconidium apically budding on the enlarged tip of the premature conidiophore, small vesicles are later seen lining the initially simple septum separating the proconidial units into conidia. The doubling of this interconidial septum is surface viewn as a thick annulus. Disarticulation of the conidial untis intervenes along a septal furrow of electroluscent material. Interconidial continuity through the septal proes is transiently insured by a connective which is ruptured for final liberation of the conidia.

Cell Nucleus↗
PubMed1991

Chondrosarcoma of the bones of the hand. Report of two cases.

Implantation of chondrosarcoma in the bones of the hands is an infrequent occurrence. We present two cases in which the fifth metacarpal and the proximal phalanx of the index finger, respectively, were affected in two patients aged 47 and 67 years, who, without previous known lesions, came to consultation on the appearance of pain and progressive local growth of tumour. After histological diagnosis we proceeded to disarticulation at the level of the affected bone. We review the literature on the appearance of this type of tumour in the hand.

Aged↗
PubMed1999

The superior orbital fissure and its contents.

Topographic landmarks for the superior orbital fissure are useful for general orientation and approach to the middle fossa, cavernous sinus and orbit. In this study, the microsurgical anatomy and morphometry of the superior orbital fissure and its related structures were examined in 57 disarticulated sphenoid bones, 102 skull bases and 58 adult cadaveric heads. The superior orbital fissure was observed in nine different shapes based on the classification of Sharma et al. (1988), and the most frequently observed was Type VI. The distance from the superomedial to the superolateral edge was measured as 17.3 +/- 3.4 mm on the right side and 16.9 +/- 2.9 mm on the left side, and from the superolateral to the inferior edge as 20.8 +/- 3.9 mm on the right side and 20.1 +/- 3.8 mm on the left side. The distance from the superomedial to the inferior edge of the fissure was measured as 9.5 +/- 2.2 mm on the right side and 9 +/- 2.4 mm on the left side. No right-left differences were observed for these measurements. Measurements regarding the relationship of the oculomotor, trochlear and abducent nerves, the ophthalmic branch of the trigeminal nerve and the superior orbital vein were performed and topographic aspects of the superior orbital fissure region were described.

Abducens Nerve↗
PubMed1997

The frontal sinus and the ethmoidal labyrinth.

In the "standard" anatomic description, the frontal bone and cribriform plate of the ethmoid bone form the base of the anterior cranial fossa. We studied the development of the ethmoidal bone as well as its relations to the frontal bone in macerated disarticulated skull bones and macerated skull bases of 35 individuals between 9 and 35 years of age. In 19 cases the ethmoidal cells were completely or partly uncovered by the frontal bone. In 6 of 19 cases the frontal bone did not cover any of the ethmoidal cells; in 10 further cases the frontal bone covered only the anterior and in 3 cases the anterior and middle ethmoidal cells. In a 60-year-old subject the ethmoidal cells were incorporated in the base of the anterior cranial fossa, a rare finding. Thus, a depressed lamina cribrosa is not the only danger in ethmoidectomy. Based on the present data ethmoidal cells uncovered by the frontal bone may involve a serious risk during ethmoidectomy even if the surgeon remains lateral to the insertion of the middle concha. The discrepancy between common descriptions of this region and our own findings may be related to imprecise data concerning the life stage of the cases described in the literature.

Adolescent↗