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D S Sheth

Publications and source records attributed to D S Sheth.

7 recordsLinked to original sources
PubMed2000

Functional and oncological outcome of acetabular reconstruction for the treatment of metastatic disease.

BACKGROUND: Metastatic disease of the acetabulum can be painful and disabling. Operative intervention is indicated for patients who fail to respond adequately to nonoperative treatment. We evaluated the functional and oncological outcome of acetabular reconstruction after curettage for the treatment of refractory symptomatic acetabular metastases. METHODS: Fifty-five patients with metastatic disease of the acetabulum were treated with operative acetabular reconstruction combined with a total hip replacement. The most common primary tumor was carcinoma of the breast (eighteen patients), followed by carcinoma of the kidney (seven patients) and carcinoma of the prostate (seven patients). Forty (73 percent) of the patients presented with multiple skeletal metastases, and eighteen (33 percent) had associated visceral metastases. Twenty-eight (51 percent) had severe pain requiring continuous use of narcotics, twenty-four (44 percent) had moderate pain requiring periodic use of narcotics, and the remaining three (5 percent) had mild pain requiring use of non-narcotic analgesics. Eighteen (33 percent) of the patients could not walk, twenty-three (42 percent) needed a walker or crutches, twelve (22 percent) used a single cane, and two (4 percent) walked without assistive devices. Intralesional curettage of the tumor was performed in all of the patients. Fifty-four of the hips were reconstructed with a protrusio cup and one, with a hemipelvis endoprosthesis. Large defects were reinforced with cement and pin or screw fixation (the modified Harrington technique), which allowed transmission of weight-bearing forces to the remaining intact pelvis. Thirty-six acetabular reconstructions were performed with antegrade pins or cannulated screws; fifteen, with long retrograde screws; and four, with cement. RESULTS: The median period of survival was nine months. Patients with visceral metastases had a median period of survival of three months compared with twelve months for patients without visceral metastases (p < 0.001). Patients with breast cancer presented later in the disease process (p < 0.004) and lived longer than did those with other carcinomas (p < 0.004). Forty-five patients were evaluated three months after reconstruction. Thirty-four (76 percent) of them had relief of pain as determined by decreased use of narcotics. Nine of the eighteen patients who could not walk preoperatively regained the ability to walk. Fourteen of the seventeen patients who originally were able to walk in the community retained that ability. Thirty-three patients were available for evaluation at six months. Twenty-five (76 percent) still had relief of pain, and nineteen (58 percent) were able to walk and function in the community. Overall, fourteen (25 percent) of the fifty-five patients had moderate local progression of the disease, and five of these patients had failure of the fixation. Fourteen early complications developed in twelve (22 percent) of the patients. One patient (2 percent) died perioperatively. CONCLUSIONS: Patients who have acetabular metastases that are refractory to radiation and chemotherapy have a short life expectancy. The early, gratifying results of reconstruction validate the role of operative treatment as a short-term palliative procedure. Protrusio acetabular cups presumably compensate for deficiencies of the medial wall, while cement and pin fixation can be used effectively to reconstruct large defects in the acetabular column and dome. The low rate of fixation failure supports the biomechanical principles of the reconstruction. Generally, the reconstructions are sufficiently durable to exceed the life expectancy of the patients.

Acetabulum↗
PubMed1996

Conventional and dedifferentiated parosteal osteosarcoma. Diagnosis, treatment, and outcome.

BACKGROUND: Dedifferentiated parosteal osteosarcoma (dd-POS) designates high grade transformation, of conventional low grade parosteal osteosarcoma (c-POS). The paradigm of preoperative diagnosis, neoadjuvant chemotherapy, and wide local excision has not been adequately evaluated for dd-POS, as it has been for conventional high grade intramedullary osteosarcoma. METHODS: A retrospective review was conducted of 28 patients treated at the authors' institution between January 1980 and December 1992 for an osteosarcoma arising on the surface of the bone diagnosed as either c-POS or dd-POS. The clinicopathologic features, diagnosis, treatment, and patient outcome were analyzed. RESULTS: A dedifferentiated component was identified in 12 of 28 tumors (43%). Neither the presence of radiolucencies (77% in c-POS and 100% in dd-POS, P = 0.06) nor medullary invasion (42% in c-POS and 50% in dd-POS, P = 0.28) distinguished dd-POS from c-POS. However, all patients who presented with focal hypervascularity on an arteriogram defined the high grade component of dd-POS that was confirmed by selective needle biopsy. This differed significantly (P = 0.00003) from c-POS. None of the patients with c-POS died of the disease (median survival duration, 77 months; range, 16-152 months). Six patients (35%) developed a local recurrence, but five were treated successfully with further surgery. In the dd-POS group, 7 of the 12 patients died of the disease. Ten patients with dd-POS received preoperative chemotherapy (IA cis-diamminedichloroplatinum, IV doxorubicin), and a good response (> 90% necrosis of high grade component) was observed in four. Among patients whose disease was localized, continuous disease free survival was prolonged significantly (P = 0.03) in patients with a good response (median, 75 months) compared with those who responded poorly (median, 13 months). Five patients remained continuously disease free (median, 66 months, range, 29-95 months). CONCLUSIONS: Wide surgical excision alone is adequate treatment for patients with c-POS. Recognition of dedifferentiated areas with angiography and percutaneous biopsy of hypervascular areas should prompt the administration of chemotherapy and wide local excision to optimize patient outcome.

Adolescent↗
PubMed1996

Chondrosarcoma of the pelvis. Prognostic factors for 67 patients treated with definitive surgery.

BACKGROUND: Chondrosarcoma (CS) most commonly involves the pelvis. Local and systemic failures often result in poor outcome. Prognostic factors that determine patient outcome remain ill-defined. METHODS: We retrospectively analyzed 67 patients with CS of the pelvis treated by definitive surgery from January 1970 to December 1992. All patients had localized disease including Grade 1 (19 patients), Grade 2 (18 patients), Grade 3 (17 patients), and dedifferentiated (13 patients) tumors. Thirty-two patients underwent a limb-sparing surgical resection and 35 patients underwent hemipelvectomy. Follow-up was available for all patients. The median duration of follow-up for the survivors was 115 months (range, 24-288 months). RESULTS: At last follow-up, 52% of the patients were disease free, 8% were alive with disease, 36% died of disease, and 4% died of other causes. Nineteen patients (28%) had developed a local recurrence (LR). The median time to LR was 23 months (range, 1-111 months). Independent variables in a multivariate analysis associated with increased risk of LR included inadequate surgical margin, tumor epicenter in the pubis, and high grade histology. LR did not influence overall patient survival. Twenty-three patients (36%) developed distant metastases at a median time of 9 months (range, 1-111 months) postoperatively. Metastases developed in 0% of the patients with Grade 1, 20% of the patients with Grade 2 60% of the patients with Grade 3 and 75% of patients with dedifferentiated CS. On multivariate analysis, histologic high grade was the only significant predictive variable for distant relapse (P = 0.005). CONCLUSIONS: The critical issue for a favorable outcome in low grade CS of the pelvis is adequate surgical excision (i.e., negative surgical margin). The high rate of systemic failure in high grade and dedifferentiated CS, despite adequate surgery, emphasizes the need for more effective systemic therapy.

Adult↗
PubMed1995

Giant cell tumor of the distal radius.

We compared the outcome of patients with giant cell tumor of the distal radius treated by curettage/cryosurgery and en bloc resection, evaluating oncologic success, functional results, and complications. Thirty consecutive cases of giant cell tumor of the distal radius were treated at our institution between 1958 and 1988. Twenty-six patients were available for follow-up examination, with a minimum follow-up period of 3 years and median follow-up period of 9 years. Primary curettage/cryosurgery had a local recurrence in 3 of 12, and repeat curettage/cryosurgery achieved local control in in 16 of 18 primary and recurrent cases. The major complications in this group included skin necrosis, transient nerve palsies, and fragmentation with carpal collapse. An average of 60% of contralateral range of wrist motion was preserved. Ten patients underwent en bloc excision and arthrodesis for either primary or recurrent tumor; none developed local recurrence. The main complication in this group was failure of internal fixation and non-union at the graft-radius junction. Resultant strength and function were similar in both groups. Intralesional excision with adjunctive cryosurgery is an effective alternative to en bloc excision with the advantage of preserving the distal radius and wrist joint function, but with a notable complication rate. En bloc excision with arthrodesis is more suitable for extensive local disease with poor residual bone stock and as salvage for failed intralesional excision.

Adolescent↗
PubMed1995

The treatment of aneurysmal bone cyst.

Forty-four patients with aneurysmal bone cysts were treated with curettage with or without bone grafting, and in 26 (59%) recurrence developed. Of 11 patients treated with radiation, in only 1 (9%) the disease was not controlled. In 1 patient, radiation-induced sarcoma developed. Since the introduction of cryosurgery 27 years ago, 51 patients have been treated with cryosurgery. The patients had an average age of 13 years (range, 2-32 years). Thirty-four primary aneurysmal bone cysts and 17 secondary aneurysmal bone cysts occurred in association with 7 giant-cell tumors, 5 chondroblastomas, 2 fibromyxomas, 2 nonossifying fibromas, and 1 unicameral bone cyst. The tumors were classified as inactive in 9 patients, active in 31, and aggressive in 11. Treatment consisted of local intralesional excision followed by application of liquid nitrogen. The defect was either allowed to heal spontaneously (n = 26) or was reconstructed using an intramedullary rod (n = 2), bone grafts (n = 5), fibular strut grafts (n = 14), or polymethylmethacrylate with Steinmann pins (n = 4). At median followup of 85 months (range, 24-311 months), the overall cure rate was 82%. This was increased to 96% after a second, or repeat, cryosurgery. The disease in all patients eventually was controlled by cryosurgery. The mean functional rating was 90% (range, 63%-100%). Intralesional excision with adjunctive cryosurgery is an effective method for the treatment of aneurysmal bone cyst.

Adolescent↗
PubMed1994

Conservative surgery for giant cell tumors of the sacrum. The role of cryosurgery as a supplement to curettage and partial excision.

BACKGROUND: Giant cell tumors (GCTs) of the sacrum are a difficult clinical problem. Wide excision (total sacrectomy) is associated with high morbidity and pelvic/spinal instability. Curettage with or without supplemental radiotherapy is associated with a high recurrence rate. In view of the proven effectiveness of cryosurgery as an adjunct to curettage for extremity GCT, cryosurgery was used for treatment of GCTs of the sacrum. METHODS: Seven patients with GCTs of the sacrum were treated at our institution by conservative surgery from 1973 to 1992. Four patients presented with recurrent tumors after failing previous radiation treatment (dose, 5040 cGy). Four patients were treated with curettage with cryosurgery and three with limited excision with cryosurgery. In the latter procedure after limited excision of the caudal (below S2) part of the tumor, the upper sacral segments were treated with curettage and cryosurgery. This spared the important upper sacral roots and maintained the skeletal integrity. RESULTS: At a median follow-up of 12.25 years (range, 2-14.2 years), all patients were disease free. Local recurrence developed in two patients. Both of these underwent repeat curettage and cryosurgery and have since remained disease free. Two patients had positive second look biopsy with microscopic tumor. Both of these were treated with repeat cryosurgery and have remained disease free. Two patient who developed solitary pulmonary metastases, underwent wedge resection and are alive without disease. No patient suffered neurologic deterioration. CONCLUSION: Conservative surgery (curettage or partial excision) with adjunct of cryosurgery is our preferred technique for the treatment of GCT of the sacrum. Satisfactory local control could be obtained by close observation, second look biopsy and repeat cryosurgery. The chief advantages of this method include preservation of pelvic and spinal continuity, speed and ease of surgical procedure and less potential blood loss. We recommend it over more radical sacrectomy due to low morbidity and less resultant neurologic deficits.

Adolescent↗