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Biomedical subjects

F H Sim

Publications and source records attributed to F H Sim.

At least 91 records · Page 5Linked to original sources
PubMed1990

Metastatic bone disease. A study of the surgical treatment of 166 pathologic humeral and femoral fractures.

A retrospective study of the surgical treatment of 166 metastatic lesions of the humerus and femur in 147 patients was performed. There were 106 women and 41 men whose average age was 62 years. Two-thirds of the patients were treated for complete fractures, while one-third were treated for impending fractures. Breast, lung, and kidney carcinoma accounted for the majority of the primary lesions. One-half of the patients died within nine months of surgery, while one-quarter were alive 19.1 months after surgery. The patients with breast cancer had the best prognosis, while the patients with lung cancer had the worst. The probability of implant failure increased linearly with time to 33% at 60 months. The probability of failure for the femoral lesions was greater, with 44% at 60 months. The average survival in the patients with failed fixation in the femoral lesions was 34.5 months with a mean interval to failure at 17.7 months. The failure rate was high (23%) in proximal femoral lesions treated with a compression screw or nail plate. Common reasons for failure included poor initial fixation, improper implant selection, and progression of disease within the operative field. Bone cement augmentation should be used with the fixation device when possible. Complications due to hip-screw cut-out from the head may also be reduced by applying bone cement around the screw threads.

Adolescent↗
PubMed1989

Chondroblastoma of bone.

Chondroblastomas are unusual benign lesions of bone. They classically occur at the ends of long bones in young persons. The roentgenographic and histologic features are typical. We had an opportunity to study a large number of chondroblastomas. Most of the cases came from the consultation file started by Dr D. C. Dahlin at the Mayo Clinic. This method of ascertainment may tend to load our series with unusual and atypical examples. We found some unusual locations, such as the skull and facial bones and the small tubular bones of the hands and feet. We also found some unusual histologic features, such as mitotic activity, necrosis, and cellular atypia. However, despite the unusual features, the biological behavior of these tumors was that of a benign process with only limited local aggressiveness.

Adolescent↗
PubMed1989

Solitary plasmacytoma of bone: Mayo Clinic experience.

A review of 46 cases of solitary plasmacytoma of bone was undertaken in an attempt to better define the clinical features and prognostic indicators associated with this disease. Criteria for inclusion in the study included the following: (a) solitary lytic bone lesion on skeletal survey; (b) histologic confirmation of the lesion; and (c) bone marrow plasmacytosis of less than 10 percent. Patients with extramedullary plasmacytomas and osteosclerotic lesions were excluded. All patients were evaluated with serum and urine protein studies at the time of diagnosis. The median follow-up was 90 months with a minimum of 30 months. Fifty-four percent of the lesions involved the vertebral column. The thoracic spine was the single most commonly involved site (13/46 patients). The initial lesion was treated with radiotherapy in all but three patients in whom complete surgical resection was achieved. Total doses ranged from less than 20 Gy to 70 Gy with a median of 39.75 Gy. Overall, 54% developed multiple myeloma, 2% failed with new bone lesions without multiple myeloma, and 11% developed local recurrences. No patient receiving 45 Gy or more to the solitary lesion had a local failure. While the median time to progression was 18 months, 23% of the failures occurred after 60 months. The five local failures occurred at 7, 12, 18, 40, and 114 months. The overall survival was 74% at 5 years and 45% at 10 years. The 5- and 10-year disease-free survivals, however, were 43 and 25%, respectively. Evidence of abnormal serum and/or urine protein was found in 25 of 46 patients. Neither survival nor disease-free survival was significantly influenced by the presence of abnormal proteins even if they persisted after irradiation.

Adolescent↗
PubMed1989

Surgical management of malignant melanoma of the trunk and extremities.

The surgical management of newly diagnosed melanoma should be tailored to the characteristics of the individual lesion. The actual thickness of the lesion is the main consideration in planning surgical treatment. Prophylactic lymphadenectomy is no longer routinely recommended. For early detection of clinically suspicious nodes, however, close follow-up of the patient is necessary so that therapeutic lymphadenectomy can be accomplished. Surgical intervention plays a limited role in the management of disseminated melanoma.

Arm↗
PubMed1989

Dedifferentiated chondrosarcoma of bone.

Dedifferentiated chondrosarcoma is a highly malignant variant of chondrosarcoma. Approximately 11% of chondrosarcomas can be expected to dedifferentiate into more anaplastic lesions. Radiographic evidence of a benign-appearing cartilage lesion adjacent to a lytic, highly aggressive lesion suggests dedifferentiation. Despite radical surgical treatment, the prognosis is unfavorable, with a 5 year survival rate of 10%.

Aged↗
PubMed1989

Salvage of the limb in the treatment of malignant pelvic tumors.

From 1970 through 1985, at the Mayo Clinic, sixty patients had operative treatment, with salvage of the limb, for a primary malignant tumor of the pelvis. Chondrosarcoma, osteosarcoma, and fibrosarcoma were common diagnoses. There were twenty-three iliosacral, twenty-five acetabular, and twelve ischiopubic lesions. Most of the resections were done with a wide margin and disruption of femorosacral continuity. Reconstruction included ten iliosacral, fourteen iliofemoral, and three ischiofemoral arthrodeses, and approximately 50 per cent of the procedures resulted in fusion. The average length of follow-up exceeded five years. Seventeen per cent of the patients, primarily those in whom an iliosacral lesion extended into the sacrum or along the spinal column, had a local recurrence. Twenty-one patients (37 per cent) had metastasis. The best functional results were seen after resections in which femorosacral continuity was maintained or reconstructed. If satisfactory margins can be achieved by the excision of a pelvic tumor, salvage of the limb is justified from both an oncological and a functional standpoint.

Adolescent↗
PubMed1989

Metastatic diaphyseal fractures of the shaft of the humerus. The structural strength evaluation of a new method of treatment with a segmental defect prosthesis.

The surgical treatment of extensive metastatic diaphyseal lesions of the humerus with pathologic fractures is difficult. Patients with failed internal fixation often have large segments of bone loss. Rigid fixation often is not possible in these cases. Four patients were treated with a titanium segmental defect (SD) prosthesis with good clinical results. A comparative in vitro analysis of fixation with the SD prosthesis, a Rush rod, and a dynamic compression plate (DCP) augmented with methylmethacrylate was performed. The SD prosthesis performed better than the Rush rod and DCP in both the nondestructive four-point bending test and the destructive torsional test. The reconstructed humeri using the SD prosthesis had a torsional strength approaching that of an intact specimen. Hence, the SD prosthesis is a useful adjunct device in treating patients with extensive destructive lesions of the humerus secondary to metastatic disease and hematologic malignancies and in patients with malignant diseases who have had failed attempts at internal fixation.

Adult↗
PubMed1989

Wedge resection of the symphysis pubis for the treatment of osteitis pubis.

Ten patients had a wedge resection of the symphysis pubis for the treatment of symptoms of osteitis pubis that had been recalcitrant to non-operative treatment for at least six months. Preoperatively, the average duration of symptoms was thirty-two months. The symptoms included a waddling gait and crepitus, pain, and tenderness over the symphysis pubis. The early radiographic signs of the disease were rarefaction of the adjacent pubic bones and widening of the symphysis pubis. Later signs included sclerosis and narrowing of the symphyseal joint space. Pathological examination of the resected joint revealed chronic inflammatory reaction in all patients. At an average of fourteen months postoperatively, all of the patients had marked improvement and were fully active. However, at an average of ninety-two months postoperatively, three of the ten patients were not satisfied with the result. One patient needed bilateral sacro-iliac arthrodesis for pain that was caused by instability.

Adult↗
PubMed1988

Soft-tissue sarcoma: Mayo Clinic experience.

Soft-tissue tumors encompass a wide variety of lesions and continue to pose a difficult treatment problem. The outlook, however, is improving, and there have been recent advances in pretreatment assessment, clinicopathologic correlation, and adjuvant treatment programs. We retrospectively reviewed our experience in a large series of soft-tissue tumors treated at the Mayo Clinic as well as recent experience using chemotherapy and radiation treatment.

Adult↗