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Joseph Schwab,
Cristina Antonescu, Patrick Boland,
John Healey,
Andrew Rosenberg,
Petur Nielsen,
John Iafrate,
Thomas Delaney,
Sam Yoon,
Edwin Choy,
David Harmon,
Kevin Raskin,
Cao Yang,
Henry Mankin,
Dempsey Springfield,
Francis Hornicek,
Zhenfeng Duan
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ABSTRACT: Chordomas are rare tumors of the axial skeleton for which surgical resection remains the most reliable means of cure. PI-103 is a inhibitor of PI3K/AKT and mTOR activation. This study aims to determine whether the PI3K/mTOR pathway was active in chordomas and whether their inhibition could lead to decreased proliferation and increased apoptosis.
Thirteen human chordoma were tested for activation of the PI3K/mTOR pathway. The human chordoma cell line UCH-1 was treated with increasing doses of PI-103. Inhibition of AKT and mTOR was examined and assays assessing proliferation and apoptosis were performed.
The chordoma specimen demonstrated activation of the PI3K/mTOR pathway. PI-103 inhibited the AKT and mTOR activation in the UCH-1 cell line. PI-103 inhibited proliferation and induced apoptosis in UCH-1.
The PI3K/AKT and mTOR signaling pathway is constitutively activated in chordoma. PI-103 decreases proliferation and induces apoptosis in the UCH-1 via inhibition of the PI3K/mTOR pathway.
Anticancer research 07/2009; 29(6):1867-71. · 1.73 Impact Factor
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ABSTRACT: Bone ingrowth promises more durable biologic fixation of megaprostheses. The relative performance of different types of fixation is unknown. We compared the fixation of two forms of biologically fixed femoral components: an intramedullary uncemented press-fit stem (UCS; Group 1, 50 patients) and a Compress((R)) uncemented fixation (CPS; Group 2, 41 patients). In Group 1, the overall Kaplan-Meier prosthetic survival rates were 85% at 5 and 71% at 10 years. Most failures were long-term developments. Aseptic loosening was the primary cause of failure. Stem diameters less than 13.5 mm and a diaphyseal/stem coefficient greater than 2.5 mm were associated with decreased prosthetic survival. In Group 2, the overall rate of CPS survival was 88% at 5 years. Failure of femoral fixation or fracture during the first year was the main reason for revision. Five-year survival rates were similar between the groups and we observed no difference in the functional success of the implants. We found no failures after 1-year followup in Group 2 (CPS). Any difference in prosthetic survival can only be proven by longer-term study or a randomized trial. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 07/2009; 467(11):2792-9. · 2.53 Impact Factor
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ABSTRACT: Periprosthetic fractures after massive endoprosthetic reconstructions pose a reconstructive challenge and jeopardize limb preservation. Compressive osseointegration technology offers the promise of relative ease of prosthetic revision, since fixation is achieved by means of a short intramedullary device. We retrospectively reviewed the charts of 221 patients who had Compress((R)) devices implanted in two centers between December, 1996 and December, 2008. The mean followup was 50 months (range, 1-123 months). Six patients (2.7%) sustained periprosthetic fractures and eight (3.6%) had nonperiprosthetic ipsilateral limb fractures occurring from 4 to 79 months postoperatively. All periprosthetic fractures occurred in patients with distal femoral implants (6/154, 3.9%). Surgery was performed in all six patients with periprosthetic femur fractures and for one with a nonperiprosthetic patellar fracture. The osseointegrated interface was radiographically stable in all 14 cases. All six patients with periprosthetic fracture underwent limb salvage procedures. Five patients had prosthetic revision; one patient who had internal fixation of the fracture ultimately underwent amputation for persistent infection. Periprosthetic fractures involving Compress((R)) fixation occur infrequently and most can be treated successfully with further surgery. When implant revision is needed, the bone preserved by virtue of using a shorter intramedullary Compress((R)) device as compared to conventional stems, allows for less complex surgery, making limb preservation more likely. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 07/2009; 467(11):2800-6. · 2.53 Impact Factor
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ABSTRACT: Previous studies highlight the risk of valgus ankle instability in children following vascularized fibular procedures. We have observed that persistent valgus instability results in valgus deformity in these ankles. The aim of this study was to explore the risk factors associated with valgus ankle deformity following vascularized fibular graft harvest.
We present 31 patients with minimum follow-up of 2 years and maximum of 18 years. They underwent regular clinical evaluation of their ankles and routine radiological evaluation when valgus deformity became clinically apparent.
Five patients developed valgus ankle deformities. Risk factors for development of valgus deformity included age under 14 years (P = 0.02) and short [6 +/- standard deviation (SD) 1 cm] residual fibular lengths (P = 0.02). Age-residual fibula index (age in years plus residual distal fibula length in centimeters) under 16 strongly predicted the development of ankle deformity (P = 0.0008). Short residual fibular lengths were not consistently associated with valgus deformity. Children developed focal lateral tibial epiphyseal atrophy and premature antero-medial fusion of the distal fibular physis resulting in a concave-anterior bowing of the fibula. Skeletally mature patients had congruent joints and posterior rotation of the proximal fibula without bowing.
Mechanical causes cannot solely explain valgus ankle deformity following vascularized fibula harvest. Secondary changes due to growth arrest in the ankle significantly contribute to this deformity.
Annals of Surgical Oncology 06/2009; 16(7):1938-45. · 4.17 Impact Factor
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ABSTRACT: Traumatic injuries of the hip and pelvis are common in child athletes and typically require minimal treatment. However, the presentation of such injuries can at times be clinically indistinguishable from the onset of a benign or malignant neoplastic process. In these circumstances, the orthopedic surgeon relies on modern diagnostic tools including imaging-predominantly magnetic resonance imaging (MRI) and computed tomography-and pathology studies. This article presents the cases of 2 adolescent boys with traumatic injuries to the hip, in which the threat of neoplasm could not be ruled out by in both initial imaging studies. In one case, biopsy could not conclusively rule out malignancy. In both cases, serial MRIs to monitor changes in lesion size proved valuable in determining treatment approach. The authors recommend a diagnostic algorithm to approach the differentiation of iliac hematoma from neoplasm and address the issue of waiting time in the diagnostic process. Early-and if necessary repeated-biopsy to rule out these conditions is advised, as conclusive pathologic findings are the only evidence that can rule out Ewing's sarcoma or an aneurysmal bone cyst. Given the morbidity of these conditions, the authors advocate this course of action to minimize distress to the patient and family members. Careful observation in combination with radiographic findings can yield a successful diagnosis, but the orthopedic surgeon must carefully weigh the increased risk of tumor growth against the need for biopsy.
Orthopedics 12/2008; 31(11):1144. · 2.66 Impact Factor
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ABSTRACT: We propose a surgical technique for structural allograft reconstitution of the diaphysis of long bones, maximizing surface contact between host and allograft bone. This method, analogous to a telescope, overlaps the graft and host bone, theoretically increasing bone surface contact substantially. We report the outcome of 22 telescoped allograft junction sites in 19 patients who lacked sufficient host bone to accommodate a regular-length stemmed implant. This joint-sparing reconstruction preserved 15 of 16 adjacent joints at risk for replacement. Five patients needed additional surgery, but none for nonunion. The diaphyseal length could be reconstructed enough so that a short prosthesis (less than the critical 40% of total bone length) could be used. This biologic method to reconstruct major segments of the diaphysis is best suited for patients with quantitatively or qualitatively deficient residual bone stock after tumor resection or prosthetic revision. We believe it is an excellent technique for revision knee megaprostheses when there is a short remnant of proximal femur. LEVEL OF EVIDENCE: Level IV, therapeutic study.
Clinical Orthopaedics and Related Research 11/2008; 467(7):1813-9. · 2.53 Impact Factor
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ABSTRACT: In this retrospective analysis the authors describe the assessment and outcomes of 90 patients who underwent placement of posterior instrumentation at the cervicothoracic junction following the resection of a primary or metastatic tumor during a 10-year period.
All patients underwent a posterolateral laminectomy including uni- or bilateral facetectomy, and 44 patients additionally required vertebral body resection and reconstruction. In patients who underwent C-6 or C-7 decompression, the posterior instrumentation strategies changed from the use of lateral mass plate systems (LMPSs) to lateral mass screw/rod systems (LMSRSs). Similarly, for T1-3 tumor decompression, the strategy shifted from sublaminar hook/rod systems (SHRSs) to the use of pedicle screw systems (PSSs) in which the surgeon used either a 6.25-mm rod or dual-diameter rods with or without a connector.
The overall surgical complication rate was 19% including fixation failure in 11 patients (12%), 6 of whom required reoperation. Fixation failure rates for cervical decompression decreased from 2 (29%) of 7 patients in the LMPS group to 0 (0%) of 8 in the LMSRS group (p = 0.2). The fixation failure rates for thoracic decompression were 7 (15%) of 48 patients in the SHRS group, and there was a decrease to 2 (7%) of 27 in the PSS group (p = 0.48). Neurological and functional outcomes including American Spinal Injury Association, Eastern Cooperative Oncology Group, and Medical Research Council muscle strength and pain scores remained stable or improved in 94, 96, 100, and 96% of patients, respectively.
Current posterior instrumentation strategies involving LMSRSs and PSSs provide excellent and safe stabilization of the cervicothoracic junction following resection of primary or metastatic tumors.
Journal of Neurosurgery Spine 09/2008; 9(2):111-9. · 1.53 Impact Factor
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ABSTRACT: Metastatic tumors to the spine account for significant morbidity in cancer patients. With treatment, one seeks to restore
quality of life, reduce pain, and preserve or maintain neurological function. The roles for chemotherapy, radiation therapy
(RT), and surgery continue to evolve, but clearly all play significant roles in treating metastatic spinal tumors. Initial
attempts to treat tumors using a laminectomy approach proved no better than radiation alone. Inherently, laminectomy is ineffective
for treating metastatic spine tumors because it does not effectively address anterior vertebral body or epidural tumor, and
creates iatrogenic instability. The evolution of operative approaches for metastatic spine tumors, including anterior transcavitary
and posterolateral, and the development of segmental fixation has markedly improved surgical outcomes (1–5, 7–14, 16–30). This chapter describes the authors’ indications, operative techniques, and outcomes using a singlestage posterolateral
transpedicle approach (PTA) (2), which provides exposure for epidural tumor and vertebral body resection, and anterior and posterior reconstruction.
08/2008: pages 295-302;
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ABSTRACT: Myxoid liposarcoma (MLS), the second most common subtype of liposarcoma, occurs predominantly in the extremities of young adults and has a disproportionately high tendency to metastasize to unusual soft tissue locations, before disseminated spread or pulmonary metastases. Anecdotal evidence, mainly supported by isolated case reports, suggests that a subset of these patients also develop bone metastasis, especially within the spine, which was previously under-appreciated.
In this study we investigate the incidence of osseous metastases in a well annotated sarcoma database and correlate this endpoint with clinicopathologic and molecular findings.
From a total of 230 patients with MLS diagnosis confirmed histologically, who were managed and followed prospectively at MSKCC, 40 (17%) developed skeletal metastases, comprising 56% of all metastatic events. A significant number of these bone metastases were identified early in the disease course, before the manifestation of disease in sites where sarcomas usually metastasize, such as lung. From the time of 1st metastasis, the 5 years median survival was 16%. The majority (78%) of MLS patients developing bone metastases had a histologic high grade primary tumor. The median overall survival for the high grade tumors was 55 months, as compared to 105 months for low grade cases. Eleven (84%) of 13 cases tested by RT-PCR demonstrated a type II TLS-CHOP fusion transcript.
These findings suggest that MLS has a high incidence of osseous metastases, with predilection to spine, and often associated with the most common type of TLS-CHOP transcript. Screening should include images of the spine in high-risk MLS patients to exclude spinal metastases.
Annals of Surgical Oncology 05/2007; 14(4):1507-14. · 4.17 Impact Factor
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ABSTRACT: Limb-sparing wide excision has become as effective as amputation in treating extremity sarcoma. Limb reconstruction has traditionally involved allografting. The authors evaluated reconstruction of extremity long bone defects after tumor resection using fibula free flaps.
A retrospective chart review (1991 to 2002) was performed of 25 consecutive patients at Memorial Sloan-Kettering Cancer Center who underwent reconstruction with free fibula flaps after limb-sparing resection of extremity sarcomas. Timing of reconstruction, complications, metastasis, survival, bone union, and functional outcome were analyzed. Functional assessment was based on the 1987 Musculoskeletal Tumor Society Score/Enneking classification.
Twenty-five patients (14 male patients and 11 female patients) were treated. Osteosarcoma (n = 8), Ewing's sarcoma (n = 8), and chondrosarcoma (n = 6) accounted for the majority of the cases. Reconstructed areas included tibia (n = 9), radius (n = 5), humerus (n = 6), femur (n = 4), and ulna (n = 1). All flaps survived (100 percent). One patient required emergent reexploration (4 percent), one suffered partial flap skin loss (4 percent), and three experienced postoperative infections (12 percent). In patients followed over 6 months, uncomplicated bony union was achieved in 11 of 14 patients (78 percent). After secondary procedures, bony union was ultimately achieved in 13 of 14 patients (93 percent), all of whom had good functional outcomes. Eight patients suffered local recurrences or metastases (32 percent); six died during the study period.
The microvascular free fibula flap has a lower infection rate than traditional allograft reconstruction. There is a high rate of bone union, and functional outcome is good. Thus, the authors recommend the microvascular fibula transfer as the technique of choice for reconstructing large, complex long bone defects resulting from tumor extirpation.
Plastic and reconstructive surgery 04/2007; 119(3):915-24; discussion 925-6. · 2.74 Impact Factor
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ABSTRACT: Painful metastatic bone disease remains a challenge for physicians. The treatment choices available are wide and varied, with each having its appropriate place in the management of painful bone metastases. Radiotherapy remains the mainstay of treatment with or without surgery. Advances in understanding the intricate pathway responsible for pain generation and the addition of agents such as bisphosphonates to the physician's armamentarium further assist in the management of painful bone metastases.
Current Pain and Headache Reports 09/2006; 10(4):288-92. · 1.66 Impact Factor
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ABSTRACT: Following partial or total sacrectomy, extensive soft tissue defects are frequently created. These ablations typically involve an anterior and a posterior approach, creating a large communication between the abdominal cavity and the central gluteal region. Local flap options are usually not sufficient for definitive closure of these large defects. We have found that the most useful option for reconstruction in these cases is a vertical rectus abdominis myocutaneous (VRAM) flap, passed transabdominally through the peritoneal cavity into the sacral defect during the initial anterior-approach portion of the procedure and then inset following completion of the posterior-approach final resection. Advantages of the VRAM flap are that it can supply ample skin, as well as soft tissue bulk, is easy to perform, and does not require microvascular techniques. Utilizing a prospectively maintained database, all patients over the last 14 years who underwent reconstruction utilizing a transabdominal VRAM flap following extensive partial or total sacrectomy with intraabdominal communication were identified. A retrospective chart review was then performed. Our study population consisted of 12 patients with a mean age of 58.5 years. Following sacrectomy, all patients underwent reconstruction with a VRAM flap. Flap sizes averaged 9.1 x 27 cm. Early flap complications included 3 small areas of flap necrosis at the distal, superior portion of the flap, 2 of which required minimal operative intervention of debridement and reclosure. No late flap complications have occurred, and all 12 patients completely healed, with a mean follow-up time of 29.1 months. Following sacrectomy, extensive soft tissue defects are created in the sacral area and communicate with the abdominal cavity. In these situations, we have found the inferiorly-based pedicled VRAM, passed transabdominally, to be the most reliable and useful choice of flap reconstruction. It has a low incidence of complications, low morbidity, and is easy to perform with a high success rate.
Annals of Plastic Surgery 06/2006; 56(5):526-30; discussion 530-1. · 1.32 Impact Factor
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ABSTRACT: The authors describe the preoperative assessment, intraoperative strategies, and long-term outcomes in 41 consecutive patients who underwent spinal reconstruction after resection of subaxial cervical neoplasms.
Thirty-three tumors were metastatic and eight were primary. Preoperative studies included direct laryngoscopy and vertebral artery (VA) balloon occlusion tests in selected patients. Based on the tumor location, approaches included 12 anterior, 13 posterior, and 16 combined. All patients underwent aggressive intralesional resection and spinal reconstruction. In 12 patients, the VA was dissected from the periphery of the tumor, two cases of which required ligation. Fibula allograft and an anterior rigid plate fixation were most commonly used for anterior reconstruction. Posterior reconstruction was initially performed using lateral mass plates (LMPs) in 13 patients and screw/rod systems in the remaining patients. At follow up, pain level improved to mild or was absent in 39 patients (95%) who had presented with moderate or severe pain. The American Spinal Injury Association (ASIA) Scale scores were stable in 25 patients who presented with ASIA Score E and improved in 14 patients (88%) who presented with ASIA Score B, C, or D. Functional radiculopathy significantly improved in 16 (94%) of 17 patients. Complications occurred in 10 patients (24%) and included three fixation failures requiring revision. Two fixation failures involved cervical LMP screw pullout. The overall mean survival duration was 8.6 months for patients with metastatic tumors and 33.4 months for primary tumors.
Surgery for the treatment of subaxial spine neoplasms is effective for relieving pain, encouraging functional nerve root recovery, and preserving spinal cord function with acceptable complication rates.
Journal of Neurosurgery Spine 04/2005; 2(3):256-64. · 1.53 Impact Factor
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ABSTRACT: The vascularized fibular graft is an important tool in the reconstruction of defects caused by resections of orthopedic tumors. Children often undergo this form of reconstruction, but there is little information about the complications after vascularized fibular graft harvest in this age group.
We present a series of 32 patients who underwent this procedure to reconstruct an extremity in our institution. There were 12 children and 20 adults.
The residual distal fibula was significantly longer in adults as compared with children (P < .048). Among children, 3 of 11 undergoing the procedure developed ankle instability, in distinction to adults, none of whom developed this complication (P < .041). This reflects a disruption of normal ankle function that develops in skeletally immature patients with a short residual fibula but not in patients with a longer residual fibula (P < .008). When the sum of patient age in years and residual fibula length in centimeters was less than 16, 3 of 6 patients developed deformity, in contrast to no deformity developing in the remaining 23 when the sum was >16 (P < .004). Adults were more likely to develop pain than instability.
Our series suggests that children with an age-length sum <16 should be considered for prophylactic tibiofibular synostosis creation.
Annals of Surgical Oncology 01/2005; 12(1):57-64. · 4.17 Impact Factor
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ABSTRACT: CT-guided spinal biopsy (CTGSB) is considered a safe and accurate procedure. Our goal was to determine the accuracy of a CTGSB of osseous spinal lesions in patients with known or suspected underlying malignancy in reference to major variables such as the radiographic appearance of the biopsied lesion and its location within the spinal column.
We retrospectively reviewed results of 410 consecutive percutaneous CTGSB procedures of osseous spinal lesions. Biopsy was determined to be adequate if diagnostic tissue was obtained (n = 401) or unsatisfactory (n = 9) if only blood without cellular elements was present on final pathologic-cytologic examination.
The level of spinal biopsy was cervical in nine patients (2%), thoracic in 123 (31%), lumbar in 164 (42%), and sacral in 96 (25%). The overall diagnostic accuracy of CTGSB was 89%, with a false-negative rate of 11%. Biopsy of lytic lesions yielded an accurate diagnosis in 93% (220 of 236). Despite technical challenges inherent to biopsy of sclerotic lesions, diagnostic accuracy was 76% (63 of 83), although more importantly, 24% (20 of 83) of the results in sclerotic lesions were falsely negative.
CTGSB of osseous spinal lesions is an important tool in the workup of patients with known or suspected underlying neoplastic disease. However, a negative result must be confirmed with either close follow-up or, preferably, open biopsy, especially in cases of sclerotic lesions for which diagnostic accuracy is decreased and the false-negative rate is high.
American Journal of Neuroradiology 11/2004; 25(9):1583-8. · 2.93 Impact Factor
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ABSTRACT: Patients with metastatic spine tumors often have multicolumn involvement and high-grade epidural compression, requiring circumferential decompression and instrumentation. Secondary medical and oncological issues add morbidity to combined approaches. The authors present their experience in using the single-stage posterolateral transpedicular approach (PTA) to decompress the spine circumferentially and to place instrumentation.
From September 1997 to February 2004, 140 patients with spine metastases underwent the PTA. Magnetic resonance imaging revealed high-grade spinal cord compression in 120 patients (86%) and lytic vertebral body destruction in all patients. Preoperatively 84 patients (60%) received radiotherapy directed to the involved level and 42 (30%) underwent tumor embolization. Following circumferential decompression, all patients underwent anterior reconstruction with polymethylmethacrylate and Steinmann pins, and posterior segmental fixation. The median operative time was 5.1 hours, the median blood loss was 1500 ml, and the median hospital stay was 9 days. Ninety-six percent of the patients experienced postoperative pain improvement and improvement in or stabilization of neurological status. In 51 nonambulatory patients with poor Eastern Cooperative Oncology Group grades, 75% regained the ability to walk. One month postoperatively 90% of patients achieved good-to-excellent performance scores. The overall median patient survival time was 7.7 months. Patients with colon and lung carcinomas had significantly shorter survival times. Major operative complications occurred in 20 patients (14.3%). Wound complications occurred in 16 patients (11.4%), but this was not correlated with preoperative radiation treatment.
The PTA allows circumferential epidural tumor decompression and the placement of anterior and posterior spinal column instrumention. Immediate spinal stability is achieved without the use of brace therapy. This technique achieved a high success rate for pain palliation, neurological preservation, and functional improvement, while avoiding the morbidity associated with combined approaches.
Journal of Neurosurgery Spine 11/2004; 1(3):287-98. · 1.53 Impact Factor
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ABSTRACT: Antineoplastic and antiresorptive drugs added to polymethylmethacrylate cement may prevent local cancer progression and failure of reconstructive devices used to treat patients with pathologic fractures. We tested the mechanical properties of cement containing various amounts of the drugs and found that as much as 2 g of either doxorubicin or pamidronate can be added to Simplex cement and the cement retains 87% of its compressive and tensile strength after 6 months of wet storage. Approximately 1 mg pamidronate elutes from experimental pellets. One half of the drug elution occurs within the first day in experiments that combined doxorubicin and pamidronate, and within 3 days when pamidronate was the only additive. Cement containing these drugs seems to be strong enough, but its fatigue strength should be tested before using it clinically. Sufficient amounts of the tested drugs elute to have potential biologic activity.
Clinical Orthopaedics and Related Research 11/2003; · 2.53 Impact Factor
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ABSTRACT: Patients who have undergone "mantle" field irradiation for Hodgkin's disease may develop symptomatic muscle atrophy in the treatment portal. This complication has received only scant attention in the clinical literature and its pathologic substrate has not been elucidated. We report the finding of nemaline myopathy in the previously irradiated and atrophic trapezius muscle of such a patient. Biopsy of clinically uninvolved gracilis muscle outside of the radiation portal revealed normal histology and ultrastructure. We are unaware of previous reports documenting such a phenomenon, which suggests that nemaline myopathy may evolve as a radiation-related disorder.
Human Pathlogy 09/2003; 34(8):816-8. · 2.88 Impact Factor
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ABSTRACT: Limb salvage after extremity tumor ablation may include the use of allograft bone. The primary complication of this method is infection of the allograft, which can lead to limb loss in up to 50 percent of cases. The purpose of this study is to evaluate the efficacy of primary muscle flap coverage in the setting of allograft bone limb salvage surgery. This study is a prospective review of all patients with flap coverage of extremity allografts over the 10-year period 1991 to 2001. There were 20 patients (11 male and nine female patients) with an average age of 28 years (range, 6 to 72 years). Flap coverage was primary in 16 patients and delayed in four. Delayed coverage was performed for failed wounds that did not have a primary soft-tissue flap. Pathologic findings included osteosarcoma in nine patients, Ewing sarcoma in five patients, malignant fibrohistiocytoma in two patients, chondrosarcoma in two patients, synovial sarcoma in one patient, and leiomyosarcoma in one patient. Allograft reconstruction was performed for the upper extremity in 12 patients and for the lower extremity in eight patients. Flap reconstruction was accomplished with 20 pedicle flaps in 17 patients (latissimus dorsi, 12; gastrocnemius, four; soleus, three; and fasciocutaneous flap, one) and four free flaps (rectus abdominis, three; latissimus dorsi, one) in four patients. All pedicled flaps survived. There was one flap failure in the entire series, which was a free rectus abdominis flap. This case resulted in the only limb loss noted. The follow-up period ranged from 1 to 50 months (average, 12.35 months). At the time of final follow-up, three patients were dead of disease and 17 were alive with intact extremities. The overall limb salvage rate in the setting of bone allograft and soft-tissue flap coverage was 95 percent (19 of 20). Reoperation for bone-related complications was required in 50 percent (two of four) of cases receiving delayed flap coverage compared with 19 percent (three of 16) of patients with primary flap coverage (statistically not significant). The results of this study support the use of soft-tissue flap coverage for allograft limb reconstruction. In this series, no limb was lost in the setting of a viable flap. Reoperation was markedly reduced in the setting of primary flap coverage. Pedicled or microvascular transfer of well-vascularized muscle can be used to wrap the allograft and minimize devastating wound complications potentially leading to loss of allograft and limb.
Plastic & Reconstructive Surgery 05/2002; 109(5):1567-73. · 3.38 Impact Factor
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ABSTRACT: A 61-year-old non-diabetic woman underwent a non-diagnostic FDG PET study due to ingestion of milk and sugar 150 minutes prior to injection of FDG despite being euglycaemic. A repeat study 2 days later showed 4 pathological foci of FDG uptake, of which only two could be seen retrospectively on the original study. The loss of lesion perspicuity and suppression of FDG uptake in the pathological lesions was corrected by fasting for more than 6 hours. The calculated SUV suppression due to eating could be corrected by normalizing according to the average of the patient's liver SUV. Proper patient preparation is essential in any medical procedure but even more so in FDG PET imaging, as small pathological lesions may be missed if the patient is improperly prepared.
Clinical Positron Imaging 04/1998; 1(2):131-133.
