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At least 775 records · Page 43Linked to original sources
PubMed1980

[The so-called metastasizing thyroid adenoma from the orthopaedic viewpoint (author's transl)].

The so-called metastasizing thyroid adenomas, which are now know as follicular thyroid carcinomas, present diagnostic problems again and again on account of their high degree of differentiation, since the primary tumour is often recognized as malignoma only after metastases have put in their appearance in other parts of the body. In this article, the authors report on a case of a follicular thyroid carcinoma which became manifest via a tumour of the size of an infant's head at the right upper part of the ilium.

Adenocarcinoma↗
PubMed1999

Evaluation with three-dimensional computed tomography after anterior skull base reconstruction using two musculopericranial flaps and a grafted bone.

Postoperative evaluation by three-dimensional (3D) computed tomography (CT) was performed in 15 patients who underwent anterior skull base reconstruction using two musculopericranial flaps and a grafted bone sandwiched between the two flaps. Especially in the case of large bone grafts (4 x 4 cm or more), the graft was positioned with the convex side facing upward into the cranial cavity to avoid creating an intracranial dead space. The extent of the absorption and changes in the contour of the grafted bone were evaluated. Imaging was done at a CT level of 150 using a Proceed 3-D CT scanner (Yokogawa Medical Co., Tokyo, Japan). Donor bone for grafting to the skull base was harvested the cranium in 10 patients and the ilium in 5 others. Patients ranged in age from 7 to 76 years (mean, 47); there were 10 men and 5 women. The grafted bone ranged in size from 1 x 2 cm to 5 x 8 cm (1 x 2 cm to about 4 x 3 cm: 10 patients; 4 x 4 to about 5 x 8 cm: 5 patients).No marked absorption of grafted bone was seen in these 15 patients, and no brain hernia occurred. In patients with large bone grafts (4 x 4 cm to about 5 x 8 cm), a graft that had been positioned with the convex side facing upward into cranial cavity at the time of transplant was subsequently observed to be transformed into a downward convex contour of normal skull base. Fostoperative infection did not occur because of the dead space nor were there any symptom of pressure on the brain because of the upward convexity of the grafted bone.The present reconstructive method is not only a minimum invasive but also a safe and reliable method for anterior skull base surgery.

Journal Article↗
PubMed2001

Stiffness and neuromuscular reflex response of the human spine to posteroanterior manipulative thrusts in patients with low back pain.

BACKGROUND: Studies investigating posteroanterior (PA) forces in spinal stiffness assessment have shown relationships to spinal level, body type, and lumbar extensor muscle activity. Such measures may be important determinants in discriminating between patients who are asymptomatic and those who have low back pain. However, little objective evidence is available concerning variations in PA stiffness and their clinical significance. Moreover, although several studies have assessed only load input in relation to stiffness, a more complete assessment based on dynamic stiffness measurements (force/velocity) and concomitant neuromuscular response may offer more information concerning mechanical properties of the low back. OBJECTIVE: To determine the stiffness and neuromuscular characteristics of the symptomatic low back. STUDY DESIGN: This study is a prospective clinical study investigating the in vivo mechanical and muscular behavior of human lumbar spinal segments to high loading rate PA manipulative thrusts in research subjects with low back pain (LBP). METHODS: Twelve men and 10 women, aged 15 to 73 years (mean age of 42.8 +/- 17.5 years) underwent physical examination and completed outcome assessment instruments, including Visual Analog Scale, Oswestry Low Back Disability Index, and SF-36 health status questionnaires. Clinical categorization was made on the basis of symptom frequency and LBP history. A hand-held spinal manipulation device, equipped with a preload control frame and impedance head, was used to deliver high-rate (<0.1 millisecond) PA manipulative thrusts (190 N) to several common spinal landmarks, including the ilium, sacral base, and L5, L4, L2, T12, and T8 spinous and transverse processes. Surface, linear-enveloped, electromyographic (sEMG) recordings were obtained from electrodes (8 leads) located over the L3 and L5 paraspinal musculature to monitor the bilateral neuromuscular activity of the erector spinae group during the PA thrusts. Maximal-effort isometric trunk extensions were performed by the research subjects before and immediately after the testing protocol to normalize sEMG data. The accelerance or stiffness index (peak acceleration/peak force, kg-1) and composite sEMG neuromuscular reflex response were calculated for each of the thrusts. RESULTS: Posteroanterior stiffness obtained at the sacroiliac joints, transverse processes, or spinous processes was not different for subjects grouped according to LBP chronicity. However, in those with frequent or constant LBP symptoms, there was a significantly increased spinous process (SP) stiffness index (7.0 kg-1) (P <.05) in comparison with SP stiffness index (6.5 kg-1) of subjects with only occasional or no LBP symptoms. Subjects with frequent or constant LBP symptoms also reported significantly greater scores on the visual analog scale (P =.001), Oswestry (P =.001), and perceived health status (P =.03) assessments. The average SP stiffness index was 6.6% greater (P <.05) and 19.1% greater (P <.001) than the average sacroiliac stiffness index and average transverse process stiffness index, respectively. CONCLUSIONS: This study is the first to assess erector spinae neuromuscular reflex responses simultaneously during spinal stiffness examination. This study demonstrated increased spinal stiffness index and positive neuromuscular reflex responses in subjects with frequent or constant LBP as compared with those reporting intermittent or no LBP.

Adolescent↗
PubMed2000

Acetabular augmentation using a glass-ceramic block: 3 patients followed 3-4 years.

We have developed a block of glass-ceramic to augment the dysplastic acetabulum. 3 patients with acetabular dysplasia underwent implantation of a block of glass-ceramic on the lateral surface of the ilium just above the hip joint. The patients did not require immobilization and returned to their daily lives, walking without a cane 4 weeks after the operation. The mean Harris hip score was 47 points preoperatively and 94 points 3 years postoperatively.

Acetabulum↗
PubMed2000

The Harrington reconstruction for advanced periacetabular metastatic destruction: good outcome in 32 patients.

We report the outcome in 32 patients operated on for advanced periacetabular metastatic destruction, where all but 2 had Harrington class III destruction. The patients were operated on using the Harrington reconstruction technique, where threaded pins and cement and a total hip replacement are used to reconstruct the acetabulum and ilium. The median survival was 11 (0-106+) months. 13 patients lived for a year or more. At follow-up after 1 year, 10 of the 13 were free of pain at rest and weight-bearing, 6 were walking with and 7 without support, and 11 lived outside a health care facility. 2 patients died within 2 weeks of surgery, both of excessive peroperative bleeding. 2 patients had dislocations, 1 developed a deep infection, and 2 patients deep vein thrombosis. There were no complications caused by erroneous pin placement or intraoperative thromboembolic incidents. There were no mechanical failures, or radiographic signs of loosening, of the pelvic components. The Harrington reconstruction technique is an effective and long-lasting method to relieve pain and restore function in patients with advanced periacetabular metastatic destruction.

Acetabulum↗
PubMedDate not supplied

Lead in bone. IV. Distribution of lead in the human skeleton.

Flameless atomic absorption spectroscopy was used to measure lead concentrations in samples from 5 selected human skeletal sites (tibia, skull, rib, ilium, and vertebra) obtained from 134 hospital autopsies. Lead was distributed unequally among the different bones in distinct patterns that were age-, and to some extent, sex-dependent. To estimate lead concentration of the entire skeleton, all skeletal bones were divided into 5 groups based on their approximate compact/trabecular bone ratios, considering each of our 5 sampled sites to be the prototype for each such group. Regression analysis of the 10 possible bone site pair values at different ages yielded age-related constants. These constants were incorporated into an equation we developed that can be used both to estimate mean skeletal lead concentration (Pb) of the entire body skeleton and also to predict the lead concentration at any of the other 4 bone sites if any 1 of the 5 is measured. Applications of these data to in vivo bone lead measurements are detailed with respect to selection of the site to be measured, estimation of total skeletal lead burden, anticipated variations or error, and dependence of these factors on age and sex of the sampled population.

Adolescent↗
PubMed2005

2-Butoxyethanol female-rat model of hemolysis and disseminated thrombosis: X-ray characterization of osteonecrosis and growth-plate suppression.

We recently proposed a chemically induced rat model for human hemolytic disorders associated with thrombosis. The objective of the present investigation was to apply a noninvasive, high-magnification X-ray analysis, the Faxitron radiography system, to characterize the protracted bone damage associated with this 2-butoxyethanol model and to validate it by histopathology. Groups of female Fischer 344 rats were given 0, 250, or 300 mg of 2-butoxyethanol/kg body weight daily for 4 consecutive days. Groups were then sacrificed 2 hours or 26 days after the final treatment. The treated animals displayed a darkened purple-red discoloration on the distal tail. Histopathological evaluation, including phosphotungstic acid-hematoxylin staining of animals sacrificed 2 hours after the final treatment, revealed disseminated thrombosis and infarction in multiple organs, including bones. The Faxitron MX-20 specimen radiography system was used to image selected bones of rats sacrificed 26 days posttreatment. Premature thinning of the growth plate occurred in the calcaneus, lumbar and coccygeal vertebrae, femur, and ilium of the treated animals. Areas of decreased radiographic densities were seen in the diaphysis of the femur of all treated animals. The bones were then examined histologically and showed a range of changes, including loss or damage to growth plates and necrosis of cortical bone. No thrombi were seen in the animals sacrificed at 30 days, but bone and growth plate changes consistent with prior ischemia were noted. The Faxitron proved to be an excellent noninvasive tool that can be used in future studies with this animal model to examine treatment modalities for the chronic effects of human thrombotic disorders.

Animals↗
PubMed2000

Prediction of fat and fat-free mass in male athletes using dual X-ray absorptiometry as the reference method.

The ability of bioelectrical impedance analysis and anthropometry to predict fat mass and fat-free mass was compared in a sample of 82 male athletes from a wide variety of sports, using dual-energy X-ray absorptiometry (DXA) as the reference method. The percent fat measured by DXA was 10.9+/-4.9% (mean +/- s), and fat mass was predicted with a standard error of the estimate of 1.7 kg for skinfolds and 2.8 kg for bioelectrical impedance analysis (P < 0.001). Fat-free mass was predicted with a standard error of the estimate of 1.7 kg for anthropometry and 2.6 kg for bioelectrical impedance analysis (P < 0.001). Regression of various individual skinfolds and summed skinfolds, to examine the effect of skinfold selection combinations by stepwise regression, produced an optimal fat mass prediction using the thigh and abdominal skinfold sites, and an optimal fat-free mass prediction using the thigh, abdominal and supra-ilium sites. These results suggest that anthropometry offers a better way of assessing body composition in athletes than bioelectrical impedance analysis. Applying the derived equations to a separate sample of 24 athletes predicted fat and fat-free mass with a total error of 2.3 kg (2.9%) and 2.2 kg (2.7%), respectively. Combining the samples introduced more heterogeneity into the sample (n = 106), and the optimal prediction of fat mass used six skinfolds in producing a similar standard error of the estimate (1.7 kg), although this explained a further 4% of the variation in DXA-derived fat. Fat-free mass was predicted best from four skinfolds, although the standard error of the estimate and coefficient of determination were unchanged.

Absorptiometry, Photon↗
PubMedDate not supplied

Estimating puberty in a prehistoric skeletal collection.

A method was introduced to estimate the age of puberty in prehistoric skeletal collections using stages of fusion of the epiphyses of the distal humerus, proximal radius and proximal ulna, as well as fusion of the ilium, ischium and pubis. Fusion of these bones is associated with the hormonal release coincident with the onset of puberty. Dental age-at-death and stage of fusion of these bones were compared in 22 sub-adult individuals from the Moundville (1TU500) site in Alabama, USA. The age for the onset of puberty in this skeletal sample from Moundville, including both males and females, was estimated to be 14.95 +/- 2.53 years. These results represent an initial application of this methodology to a small data set. The application of this method on a larger scale may provide a better understanding of reproductive lifespans in earlier populations, as well as insight into possible effects of nutritional or socio-economic differences on the sexual development of children within those populations.

Age Determination by Skeleton↗
PubMedDate not supplied

Paucity of hematological neoplasia after treatment of Hodgkin disease: observation after long-term follow-up at Cancer Institute, Chennai, south India.

The purpose of the study was to evaluate the incidence of second malignancies in childhood Hodgkin disease treated with COPP and COPP/ABV (replacing mechlorethamine by cyclophosphamide) chemotherapy. In 212 children with Hodgkin disease who were under 14 years of age and treated at Cancer Institute during the 25-year period of 1970-1994, the occurrence of second malignant neoplasms was analyzed as on 31 December 1999. Eighty-two percent attained complete response. The 5- and 10-year overall survival rate was 91 and 83%, respectively. In this interm report 5 cases of second malignancies were documented. All 5 were solid tumors: one each of soft tissue sarcoma, dermatofibrosarcoma, micropapillary carcinoma of thyroid, malignant phylloides tumor of breast, and chondrosarcoma of ilium. All patients had received combination chemotherapy and radiotherapy. Interestingly, all were splenectomized. All these patients had advanced stage of cancer and were 7-14 years of age at the time of diagnosis of first primary Hodgkin disease. It is significant that there were no secondary hematological malignancies. COPP and COPP/ABV are effective therapeutic regimens. The paucity of secondary hematological malignancies is unique in this series and may be attributed to the substitution of nitrogen mustard with cyclophosphamide in the chemotherapy combination. This is an initial observation, and further follow-up is needed for a firm conclusion.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Critically sized osteo-periosteal femoral defects: a dog model.

A 21-mm defect was created in 1 femoral diaphysis each of 15 dogs. Periosteum as well as a cylinder of bone was removed, and the defect was stabilized with a bone plate. Twelve of the defects were filled with an equal volume of autogenous cancellous bone harvested from the ipsilateral ilium. Three defects were left untreated. Cranial to caudal radiographs were taken postoperatively and every 4 weeks for 16 weeks. The radiographs were evaluated for healing using two ordinal scales. At 16 weeks, the dogs were euthanized and the femurs harvested for biomechanical testing and histologic evaluation. Both operated and contralateral not operated femurs were mechanically tested to failure in torsion, and load at failure and stiffness were calculated. All dogs tolerated the procedure well, and were using the operated limb within 1 or 2 days postoperatively. There were no complications noted during the 16 weeks of the study. Unfilled defects did not heal and became atrophic nonunions. The defects filled with autogenous cancellous bone healed in a consistent pattern of consolidation, incorporation, and remodeling, with uniform increases of both ordinal scales used. The femoral cortex opposite the bone plate demonstrated most mature remodeling, evident both radiographically as well as histologically. Unoperated femurs failed at 13.61 +/- 3.88 N-m and grafted femurs failed at 2.96 +/- 1.3 N-m, which was 23% of the measurement of the unoperated femur. Relative stiffness of the unoperated femurs was 5974 +/- 4316 N-m2/radian, and grafted femurs had a relative stiffness of 642 +/- 561 N-m2/radian, which was 10.4% of the measurement of unoperated femur. This model proved to be a critically sized defect, which when left unfilled resulted in an atrophic nonunion, and when filled with cancellous bone resulted in a consistent healing pattern.

Animals↗
PubMed1997

Intramarrow cytokine gene transfer by adenoviral vectors in dogs.

Daily systemic administration of hematopoietic growth factors can be associated with dose-limiting systemic side effects. To overcome this, we have investigated hematopoietic cytokine gene transfer to the marrow cavity of dogs by direct intramarrow injection of adenoviral vectors. In marrow culture, replication-deficient (E1-deleted) adenoviral vectors were able to transduce marrow stromal cells, demonstrating 30-fold greater expression than from other marrow cell types. High-level (ng/ml) cytokine production from transduced stromal cells persisted for 14 days in culture. Because adenovectors could efficiently transduce marrow stromal cells in culture, we investigated if stromal cells could also be transduced in vivo following direct intramarrow vector injection. Adenovectors with genes for interleukin 6 (IL-6) and Lac Z (beta-galactosidase) were injected directly into the marrow cavity of dogs resulting in protein expression localized to within the treated marrow. To evaluate this approach further in dogs, we constructed a vector expressing biologically active canine granulocyte-macrophage colony stimulating factor (GM-CSF). 293 cells infected with ADGM-CSF demonstrated prevalent GM-CSF mRNA by Northern blot and 135 +/- 30 ng/ml of protein as measured by enzyme-linked immunosorbent assay (ELISA). In vitro bioactivity of protein expressed was confirmed by canine GM colony-forming assay (CFU-GM). In vivo high-level protein production was noted in supernatants of marrow aspirates 72 hr following direct intramarrow administration of ADGM-CSF (baseline mean +/- SEM, 27 +/- 22 ng/ml, 72-hr sample 921 +/- 461 ng/ml). A localized myeloid expansion of marrow and significant peripheral leukocytosis (neutrophilia) were noted in all ADGM-CSF-treated dogs. Peripheral blood changes lasted for up to 3 weeks in dogs following single intramarrow injection. Thus, adenoviral cytokine expression from the marrow of a single large bone (ilium) led to compartmentalized expression of growth factor and an increase of hematopoiesis sufficient to cause peripheral blood changes in a large animal model.

Adenoviridae↗
PubMed1986

Postradiation malignant fibrous histiocytoma of bone. A clinicopathologic study of 20 patients.

Among the 130 primary or secondary malignant fibrous histiocytomas of bone diagnosed and treated at Memorial Hospital for Cancer and Allied Diseases during the previous half century, 20 (15.4%) arose as a direct consequence of irradiation. This type is the commonest secondary osseous malignant fibrous histiocytoma at this institution. It affects the ilium, the scapula, and the distal end of the femur most frequently, predominantly in patients whose age peaks in the fifth decade of life, when their sarcomas developed. Grounds for the irradiation were either nonosseous conditions (13 patients) or preexistent skeletal lesions (seven patients). Reasons for the incidental bone irradiation included Hodgkin's disease; carcinoma of cervix, breast, or lung; bilateral retinoblastoma, and others; giant cell tumors predominated among the irradiated skeletal lesions. The mean and the median radiation doses were 6,040 and 5,700 rads, respectively. The latent period between irradiation and the appearance of the bone sarcoma ranged from 4 to 47 years with a mean of 16.5 and a median of 14.5 years, respectively. The cumulative disease-free survival rate at 3 years was 58%. Although all patients who received their radiation therapy for a preexistent bone lesion survived, only 27% of patients whose bone was normal at the time of irradiation are alive and well at the 3-year mark.

Adolescent↗
PubMed1996

Dedifferentiated chondrosarcoma with rhabdomyosarcomatous differentiation.

Dedifferentiated chondrosarcomas are primary bone tumors characterized by the presence of both low-grade cartilaginous and high-grade sarcomatous components. The high-grade component usually shows histologic features of either malignant fibrous histiocytoma or fibrosarcoma. We are aware of only 10 published cases in which the high-grade component showed rhabdomyosarcomatous differentiation. To further clarify the clinical, radiographic, and pathologic features of this unusual variant, we report three additional cases of dedifferentiated chondrosarcoma with rhabdomyosarcomatous differentiation. The patients included two men and one woman; their mean age was 63 years. Tumors originated in the pelvis (ilium), scapula, and tibia. Two patients presented with radiographic findings typical of dedifferentiated chondrosarcoma, including a geographic, lytic lesion with areas of mineralization suggestive of cartilage in close association with a permeative component. The third patient presented with a primarily lytic, destructive lesion of the right iliac wing. Histologically, the tumors contained lobules of well-differentiated chondrosarcoma associated with a high-grade sarcoma with prominent rhabdomyoblasts. Immunohistochemical stains for actin and desmin were positive in all three tumors, and electron microscopy revealed evidence of skeletal muscle differentiation. All three patients died with metastatic disease, 1, 6, and 12 months postoperatively. This histologic variant of dedifferentiated chondrosarcoma is rare, but it shows radiographic and clinical features similar to "conventional" dedifferentiated chondrosarcoma, including a very poor prognosis.

Aged↗
PubMed1990

Axial flaps for treatment of penis lesions due to granulomas.

Granulomas can result from subcutaneous injection of ointment into the penis to augment its bulk. Rigid, infiltrated granulomatous and scar tissue prevents coitus, often ulcerates, and must be excised. Large segmental or circumferential defects of the penile integument must be covered with soft, pliable skin. We describe our experience with axial skin-fat flaps taken for this purpose from the groin region. There are two well-known vascular bundles, the arteria circumflexa ilium superficialis (ACIS) and arteria epigastrica superficialis (AES). Both were used successfully (the ACIS in 3 patients and the AES in 1) to provide island skin territories sufficient for resurfacing even a completely degloved penis (1 patient) with primary donor wound closure and rapid healing. In addition, a new flap, based on the arteria pudenda externa, was designed and implemented in 1 patient. The donor potential of the groin and lower abdominal region amply meets the requirements for penis reconstruction. Therefore, it is surprising that axial flaps have not yet become broadly accepted.

Adult↗
PubMed1994

Free vascularized iliac osteomusculocutaneous flaps based on the lateral circumflex femoral system for repair of large mandibular defects.

A free vascularized iliac osteocutaneous flap based on the ascending and transverse branches of the lateral circumflex femoral system was studied by cadaveric investigation. These composite flaps were successfully used in 2 patients with both large mandibular and soft-tissue defects. The advantages of this flap are that (1) the distal portion of the flap is relatively thin, (2) the pedicle vessels are long and large, (3) the skin territory is extremely wide, (4) repositioning of the patient during the operation is unnecessary, (5) the flap can be elevated while the recipient mandibular region is resected by two teams because the donor site is far from the head and neck regions, (6) the donor scar is in an unexposed area and its location permits easy concealment, and (7) subtotal loss of the mandible can be reconstructed with the use of split crests from either side of the ilium because the external and the internal cortices are fed independently by the lateral circumflex femoral and the deep circumflex iliac systems. This appears to be a new concept for reconstruction of total mandibular loss.

Aged↗
PubMed1980

Is amputation necessary for sarcomas? A seven-year experience with limb salvage.

The rationale for amputation for local tumor control of skeletal and soft tissue sarcomas was based on results obtained from surgical therapy alone. However, our previous results from a pilot trial of multimodality therapy of preoperative chemotherapy and radiation therapy followed by surgical resection indicated that limb salvage (without amputation) could be accomplished in most patients with little morbidity and low recurrence rate. This report summarizes our experience in a prospective trial from January 1972 to December 1979. A total of 105 consecutive patients with soft tissue sarcomas (65 patients) or bone sarcomas (40 patients) were treated with preoperative intraarterial adriamycin, 3500 rads of rapid-fraction radiation and radical en bloc resection of primary tumor. Diseased bones were replaced with cadaver allografts (22 patients), metallic endoprostheses (10 patients) autologous bone (2 patients), or no replacement (ilium or fibula-4 patients). Salvage of a viable, neurologically intact, functional extremity was achieved in 98/105 patients (98%); 97% of limb salvage patients were free of local recurrence after a median follow-up period of 28 months. Major complication rate that required amputation was 3/105 patients (2%). Postoperative adjuvant chemotherapy with cyclical adriamycin and high-dose methotrexate was employed for all patients with osteosarcoma and 35 patients with grade III soft tissue sarcomas. The overall disease-free rate is 50% (18/35) for osteosarcomas and 65% (42/65) for soft tissue sarcomas. These results indicate that local tumor control can be achieved in 91% of patients without amputation. Their functional capabilities are excellent with a low complication rate. Since the advent of adriamycin and methotrexate has significantly improved the overall survival for patients with skeletal and soft tissue sarcomas, the quality of this survival has become even more important. Preoperative multimodality therapy is a major advance in this direction and since results of limb salvage procedures appear to be equal or superior to those achieved by amputation we believe these alternatives should be offered to all patients.

Adolescent↗