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D J Pritchard

Publications and source records attributed to D J Pritchard.

At least 37 records · Page 2Linked to original sources
PubMed1995

A review of 40 patients with extraskeletal osteosarcoma.

BACKGROUND: Extraskeletal osteosarcomas are rare malignancies that account for about 1% of all soft tissue sarcomas. Few large series have been reported. METHODS: Clinical records and histologic slides of all patients with extraskeletal osteosarcomas treated at the Mayo Clinic between 1915 and 1988 were reviewed. RESULTS: The study group consisted of 40 patients, most of whom presented in the sixth and seventh decades of life (mean age, 50.7 years). There was a male predominance (male-to-female ratio, 1.9:1). The lower limbs most commonly were involved (68%), usually the thigh and buttock regions. Ninety-three percent of tumors presented as an enlarging soft tissue mass, with a history of trauma in nine patients. In nine patients, the lesions were initially interpreted histologically as benign, most commonly as myositis ossificans. Histologically, all were high grade osteosarcomas. Multiple local recurrences (45%) are a feature of this tumor. All recurrences occurred within 3 years. Distant metastasis (65%) is also common and is usually to the lungs (81%). Radical resections appear to be the best option for local control, with resection of the pulmonary metastasis occasionally producing a cure. By univariate analysis of Kaplan-Meier survival curves, the patients with predominantly chondroblastic tumors fared better than those with predominantly osteoblastic tumors (P = 0.03). Analysis of survival differences of the three main subtypes together (osteoblastic, chondroblastic, and fibroblastic) was not significant. A small-sized initial lesion did not equate with better survival. Seventy-three percent died of the disease, with a mean follow-up of 5.9 years. CONCLUSION: Extraskeletal osteosarcoma is a high grade malignant tumor associated with a 5-year survival rate of 37% (95% confidence interval, 28%-59%). Local recurrences and distant metastasis are common and usually occur by 3 years after excision. Patients with the chondroblastic subtype survive longer than those with the osteoblastic subtype.

Adult↗
PubMed1995

Patterning and regeneration of surfaces with antibodies.

We describe the application of a new technique for the site-specific immobilization of six different proteins within an area of 200 microns x 50 microns. The procedure involves coating the surface with deglycosylated avidin, which binds a photoactive biotin analogue, so providing a light-addressable surface onto which proteins can be immobilized. This is the first time that consecutive patterning of a number of different proteins has been described, and we demonstrate this with the fabrication of an immunospot for the qualitative visualization of the binding of multiple antigens. We also show that such a structured surface can be readily regenerated and subsequently repatterned.

Antibodies↗
PubMed1995

Photo-patterning of sensor surfaces with biomolecular structures: characterisation using AFM and fluorescence microscopy.

The miniaturisation of biosensors has resulted in the need to develop techniques for the high resolution patterning of different biological molecules onto surfaces. In this paper, we describe a procedure for the selective deposition of antibodies using biological self-assembly with photo-activation of a bound ligand, and we will detail methods which may subsequently be used to characterise the resultant biomolecular constructs.

Antibodies, Monoclonal↗
PubMed1995

Lung cancer complicating pregnancy: case report and review of literature.

Lung cancer during pregnancy is rare. Herein we describe a case of metastatic cancer of the lung in a 36-year-old pregnant patient whose initial complaint was pain in the left thigh. Management of this neoplasm during pregnancy depends on the gestational age of the fetus and the potential operability of the tumor. Surgical, chemotherapeutic, and radiation management considerations are discussed.

Adenocarcinoma↗
PubMed1995

Survival after pulmonary metastasectomy in soft tissue sarcoma. Prognostic factors in 214 patients.

This retrospective study examines prognostic factors for post-metastasectomy survival in soft tissue sarcoma patients. Between 1976 and 1992, 274 consecutive patients (median age 49 [7-96] years) with pulmonary metastatic soft tissue sarcoma of the extremity or trunk wall (31 at presentation) were managed at the Mayo Clinic. 214 underwent pulmonary metastasectomy and 163 of these also received adjuvant chemotherapy. There were 195 local excisions, 14 lobectomies, and 5 pneumonectomies. 90 patients had solitary metastases, 184 patients had 2 or more metastases. 31% of patients had MFH tumors and 88% of all tumors were high grade. Median follow-up for survivors was 8 (2-21) years. 5-year overall survival after metastasectomy was approximately 40% (cf. 20% for non-metastasectomy). Age > 50, MFH tumors, > or = 2 metastases, metastasis size > 2 cm, metastasis-free period < or = 18 months, and the use of adjuvant chemotherapy were univariately unfavorable factors. Size of metastasis > 2 cm, number of metastases > or = 2, and metastasis-free interval < or = 18 months were independently unfavorable for survival. In a prognostic system, patients with 0 risk factors had a 60% 5-year survival, those with 1, 2, or 3 of these factors had 30%, 20% and 0% survival, respectively.

Adolescent↗
PubMed1995

Current combined treatment of high-grade osteosarcomas.

The evaluation and treatment of osteosarcoma have evolved considerably over the past 2 decades, with corresponding dramatic improvements in prognosis. In large part, the improved outlook is attributable to intensive multiagent adjuvant chemotherapy, with better imaging modalities and reconstructive techniques also playing an important role. The current standard treatment for nonmetastatic osteosarcoma includes neoadjuvant chemotherapy, limb-sparing "wide" surgical resection, and reconstruction of the defect. Approximately 80% of patients are spared amputation. Limb salvage should be considered when an adequate surgical margin is attainable without significant neurovascular compromise and the surgical reconstruction is likely to provide better function than amputation. Because a good chemotherapeutic response is an important favorable prognosticator, much recent attention has been focused on predicting response preoperatively to allow closer surgical margins. Aggressive surgical treatment of pulmonary metastases has also been of measurable benefit.

Bone Neoplasms↗
PubMed1995

Lymphangiosarcoma following mastectomy.

This study reviews 16 cases of lymphangiosarcoma of the upper extremity after mastectomy for breast cancer (Stewart-Treves syndrome) was done at the author's institution from 1970 to 1992. Lymphangiosarcoma was diagnosed an average of 10.6 years (range, 5.6-18 years) after the diagnosis of breast cancer. Presenting signs included a bruise (6 patients); increased swelling (4); a red, raised lesion (2); a palpable mass (2); a blister appearance (1); and a non-healing eschar with continual bleeding (1). After biopsy, surgical treatment included forequarter amputation (8 patients), wide excision with grafting (5), and above-elbow amputation (1). Local recurrence of the lymphangiosarcoma occurred on the chest wall in 11 of the 16 patients after an average of 10.9 months. Metastasis occurred in 11 patients. (Metastasis occurred in 1 patient without local recurrence, and 1 patient with locally recurrent lymphangiosarcoma died of breast cancer before evidence of metastatic lymphangiosarcoma.) There are 2 long-term survivors who have lived 9.3 and 6 years, respectively, since the operation. One had been treated with a forequarter amputation and the other with wide excision. Early recognition and surgical treatment seem to offer the only chance for long-term survival.

Adult↗
PubMed1994

Primary Ewing's sarcoma of the spine.

Thirty-six patients with primary Ewing's sarcoma of the spine were diagnosed at the Mayo Clinic between 1951 and 1988. The mean age was 17 years (range, 5-40 years). Neurologic symptoms and signs were seen in 58% of the patients. Forty-seven percent of all patients had an open biopsy of the lesion and underwent a decompressive laminectomy. Three of the four patients with thoracic or thoracolumbar involvement had progressive kyphosis after laminectomy. All patients received radiation therapy in various dosages. Sixteen of the patients were registered in the Intergroup Ewing's Sarcoma Study. Intensive combination chemotherapy was administered to 32 of the patients. Nine patients were free of disease at the final follow-up examination (follow-up ranged from 6 to 184 months). The 5-year survival rate was 33%. The mean survival time was 2.9 years. No significant correlation was found between the location of the tumor in the spine and the length of disease-free survival, overall survival, or incidence of metastatic disease. Patients enrolled in the Intergroup Ewing's Sarcoma Study had significantly better rates of disease-free survival and overall survival.

Adolescent↗
PubMed1993

External beam and intraoperative electron irradiation for locally advanced soft tissue sarcomas.

PURPOSE: Intraoperative irradiation with electrons was used in conjunction with external beam irradiation and maximal surgical resection in 20 patients with locally advanced soft tissue sarcomas or desmoids. This manuscript presents results with regard to tolerance of treatment and its impact on tumor control and survival. METHODS AND MATERIALS: Ten patients presented with previously untreated primary sarcomas and 10 at the time of local recurrence (two had recurrent desmoid tumors). Tumor location was retroperitoneal in 19 and in the low anterior neck in one. A partial or gross total resection was performed prior to the external beam or intraoperative component of irradiation in every patient, but all had positive resection margins. Patients received 4500-6000 cGy of fractionated, external beam irradiation and an IORT dose of 1000-2000 cGy. Chemotherapy was given only at the time of disease progression. RESULTS: Fourteen of 20 patients (70%) were alive; 11 (55%) were free of disease (4/10 primary, 7/10 recurrent), but 1 required hemipelvectomy for salvage. Progression within the intraoperative irradiation field was documented in only 1 patient (5%) and within the external beam field in 3/20 (15%). Blood born distant metastasis occurred in 5 patients (25%) and peritoneal seeding in 1 (5%). The distant failure incidence by grade was 1/8 (13%) for Grades 1, 2 and 5/12 (42%) for Grades 3, 4. Only 1 patient (5%) developed a > or = severe neuropathy, and small bowel obstruction requiring exploration also occurred in a single patient. CONCLUSION: In view of acceptable tolerance and the high current rate of local tumor control, in spite of incomplete surgical resections, further evaluation of intraoperative irradiation as a component of treatment is indicated for locally advanced primary and recurrent soft tissue sarcomas.

Adult↗
PubMed1993

Osteofibrous dysplasia: clinicopathologic study of 80 cases.

A thorough review of the clinical, radiologic, and histologic features of 80 cases of long bone osteofibrous dysplasia is presented. Of the six cases of osteofibrous dysplasia immunostained with a cytokeratin antibody, two were cytokeratin positive; however, the five cases of fibrous dysplasia that were stained were all negative. Follow-up (mean, 5.4 years; range, 1 month to 31 years) data were available for 41 cases (51%). From the consultation series nine of the 18 patients studied had recurrences, regardless of the different treatment regimens. The average recurrence interval in these patients was 2.7 years. Two patients had incomplete excision and six had biopsy only. All eight of these patients had residual tumors. Among the 16 Mayo Clinic patients, one had recurrence 5 years after the initial treatment. In two cases, 7-year-old and 6-year-old boys, histologic maturation to fibrous dysplasia was observed 4 and 10 years later, respectively. Adamantinoma has not developed in any of the 41 cases of osteofibrous dysplasia for which we have follow-up information. It seems clear that osteofibrous dysplasia does not progress to adamantinoma. Our study suggests that osteofibrous dysplasia is probably a variant of fibrous dysplasia, as demonstrated by the maturation of two lesions of osteofibrous dysplasia to fibrous dysplasia. Surgical treatment may be appropriate in cases with an extensive lesion, pseudoarthrosis, and accentuated tibial bowing. The overall prognosis is good, even with recurrence.

Adolescent↗
PubMed1993

Ewing sarcoma of the pelvis. Clinicopathological features and treatment.

The results of treatment in twenty-seven patients who had a Ewing sarcoma of the pelvis were reviewed. Six patients had had metastatic disease at the time of the diagnosis. The three-year actuarial survival of these patients was 17 per cent (95 per cent confidence interval, 8 to 52 per cent). Of the twenty-one remaining patients, thirteen had received chemotherapy and radiation therapy to the primary lesion and eight had had chemotherapy and operative resection, with or without radiation therapy. The actuarial five-year over-all survival was 25 per cent (95 per cent confidence interval, 6 to 51 per cent) in the group that had had radiation without a resection and 75 per cent (95 per cent confidence interval, 31 to 93 per cent) in the group that had had a resection (p < 0.005, log-rank method). The actuarial over-all five-year survival was 45 per cent (23 to 65 per cent) for all patients who had had localized disease when first seen. Actuarial local failure analysis (the censoring of patients who died without evidence of local failure before the two-year follow-up examination) revealed a rate of local failure of 44 per cent (14 to 79 per cent) in the group that had been treated with chemotherapy and radiation alone compared with 13 per cent (0 to 53 per cent) in the patients who had had a resection, but this difference was not significant (p > 0.25, log-rank method).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

A comparative analysis of subchondral replacement with polymethylmethacrylate or autogenous bone grafts in dogs.

A comparative analysis was made of subchondral replacement with polymethylmethacrylate and autogeneic bone grafts in defects in the medial femoral condyles of dogs. The defect produced a 50% reduction in subchondral stiffness. An in vitro preparation helped establish that subchondral stiffness returned to normal after reconstruction with polymethylmethacrylate. The in vivo model demonstrated a reduction in subchondral stiffness in both groups at three weeks, but the bone grafted side returned to normal and the methylmethacrylate side recovered to 79% of the control at 12 weeks. There were no deleterious effects on the articular cartilage in either group when analyzed histologically and biochemically. A marked increase in new bone formation and subchondral porosity was found in the polymethylmethacrylate groups. This study supports the clinical use of subchondral polymethylmethacrylate after the exteriorization and curettage of benign bone tumors such as giant cell tumors.

Animals↗
PubMed1993

Malignant fibrous histiocytoma of the soft tissues of the trunk and extremities.

Malignant fibrous histiocytoma (MFH) is the most commonly diagnosed soft-tissue sarcoma. Of 408 retrospectively reviewed patients with MFH, 220 patients had primary, localized, previously untreated tumors involving the extremities or limb girdles. Univariate statistical analysis of results revealed five prognostic factors that were significantly related to poor outcome: old age, deeply seated lesions, surgical grade, large size, and marginal or intralesional surgery. Multivariate analysis revealed only three factors that were significantly related to poor prognosis: old age, deeply seated lesions, and inadequate surgery.

Adolescent↗
PubMed1993

A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system.

The need for a standardized system of end result reporting of various surgical alternatives after limb salvaging and ablative procedures for musculoskeletal tumors was clearly recognized during the first International Symposium on Limb Salvage (ISOLS) in 1981. During the ensuing four biannual symposia, there has been an ongoing developmental experience with a system extensively field tested in 1989 by the Musculoskeletal Tumor Society (MSTS). This system of functional evaluation has been adopted by the MSTS and ISOLS for their joint studies and program presentation. In brief, the system assigns numerical values (0-5) for each of six categories: pain, and function and emotional acceptance in upper and lower extremities; supports, and walking and gait in the lower extremity; and hand positioning, and dexterity and lifting ability in the upper extremity. Demographic information and a patient satisfaction component is included. A numerical score and percent rating is calculated to allow for comparison of results. The system has been field tested in 220 patients with low (+/-) interobserver variability. It was well accepted by the participants, and its usage is recommended by the MSTS to facilitate valid comparative end result studies of musculoskeletal tumor reconstructions.

Activities of Daily Living↗
PubMed1993

Integration of limb-sparing surgery, brachytherapy, and external-beam irradiation in the treatment of soft-tissue sarcomas.

Advances in the integration of limb-sparing surgery and adjuvant radiation therapy have nearly eliminated the need for ablative or radical resections in the management of soft-tissue sarcomas. The combination of wide or marginal surgical resections, brachytherapy, and external-beam irradiation resulted in a local recurrence rate of 9% in 68 patients followed for a minimum of two years. All recurrences were in nonsubcutaneous high-grade lesions. Treatment-related morbidity occurred in 22% of patients. Wound-healing complications developed in 17% and resolved with nonoperative treatment in half. These results support the efficacy of limb-sparing surgery and adjuvant radiation therapy in the management of soft-tissue sarcomas. Integration of chemotherapy may be necessary for the higher-grade lesions, although effectiveness is uncertain.

Adolescent↗
PubMed1993

Segmental total knee arthroplasty after distal femoral resection for tumor.

Sixty-one patients treated with custom-made segmental total knee reconstruction after resection of a primary tumor of the distal femur were reviewed retrospectively. Two types of implants were used: the Walldius hinge prosthesis (Walldius Group, n = 45) and the Kinematic rotating hinge prosthesis (Kinematic Group, n = 16). The mean periods of follow-up observation were 6.4 years for the Walldius Group and 2.3 years for the Kinematic Group. The overall functional results in the Walldius Group were excellent in 7%, good in 26%, fair in 25%, and poor in 42% of the patients. Roentgenographic analyses showed that 50% of the patients had bony resorption, 33% had interface loosening, and 10% had prosthetic stems that were broken at the time of last follow-up evaluation. Forty-two complications occurred in 34 patients who needed additional surgical treatment. Nine of the prostheses in the Walldius Group failed (20%), and 27 of the complications (64%) associated with the use of the Walldius prosthesis occurred in the first three years after implantation. Nineteen Walldius prostheses (42%) were revised or removed for reasons other than local recurrence. The overall functional results of the Kinematic Group were as follows: excellent in 25%, good in 44%, fair in 25%, and poor in 6% of the patients. Roentgenographic analysis showed that there was no change in bone on 81% of the discharge roentgenograms, that there were no radiolucent lines in 87% of the prosthetic replacements, and that there were no radiolucent lines less than 2 mm thick on the roentgenograms. None of the Kinematic rotating hinge prostheses required revision, except one with a patellar button fracture, which was revised without compromising the functional results. Four complications occurred in three patients in the Kinematic Group, and two of them required surgical treatment. The patients with the Kinematic rotating hinge prosthesis had better early functional and roentgenographic results and fewer complications.

Adolescent↗