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Biomedical subjects

Harish S Hosalkar

Publications and source records attributed to Harish S Hosalkar.

At least 19 recordsLinked to original sources
PubMed2006

Nerve palsies related to pediatric upper extremity fractures.

In every child who has a fracture, neurologic examination is essential at initial assessment so that early diagnosis of nerve injury can be made. Electrodiagnostic studies may be helpful in diagnosis when the examination is equivocal and in follow-up to look for signs of recovery. In a patient who has neurologic deficits associated with a fracture, nerve exploration should be considered for open fractures, fractures that require open reduction, and palsies that develop after fracture reduction. For closed fractures associated with nerve palsy at the time of initial injury, observation and serial examination after reduction is recommended. If there is no return of nerve function on examination or electrodiagnostic testing by 4 months, operative exploration is indicated.

Child↗
PubMed2006

Desmoid tumors and current status of management.

Desmoid tumors, also known as aggressive fibromatosis, are rare fibroblastic tumors that exhibit a wide range of local aggressiveness, from largely indolent to locally destructive. Understanding of the pathogenesis and the great heterogeneity in the natural history of desmoid tumors is invaluable to the development of therapeutic strategies. The optimal treatment protocol has not yet been established and, in many cases, a multidisciplinary approach including surgery, chemotherapy, and radiation therapy has been employed. The rarity of cases in even major tumor centers has traditionally limited the ability to study this disease. Several novel pharmacologic and biologic treatment approaches are actively being developed, although long-term follow-up is needed for their substantiation.

Adolescent↗
PubMed2006

Case reports: an unusual complication of radiofrequency ablation treatment of osteoid osteoma.

Osteoid osteoma is a benign bone tumor traditionally treated nonoperatively or by operative excision. However, radiofrequency ablation is being used increasingly for treatment, as there are several reports supporting its effectiveness. Radio-frequency ablation is precise, minimally invasive, safe, effective, and associated with minimal complications and reduced use of healthcare resources. We report a patient treated with radiofrequency ablation for tibial osteoid osteoma and thermal necrosis of the skin.

Adult↗
PubMed2005

Three-dimensional tomography of relapsed infantile Blount's disease.

Three-dimensional computed tomography reconstructions were done in the preoperative workup of five patients receiving Ilizarov correction for relapsed infantile Blount's disease. There were four girls and one boy with a mean age of 9 years 11 months. In all patients, the computed tomography reconstruction images made assessment of the deformity easier and revealed abnormalities not readily seen on plain radiographs. This information has particular relevance to medial plateau elevation using the Ilizarov frame because it is possible to correct a medial and posterior slope of the tibial plateau using this technique. Also, this imaging modality is safe, easy to do, and is a useful adjunct for planning before surgical correction of relapsed Blount's disease.

Bone Diseases, Developmental↗
PubMed2005

The diagnostic accuracy of MRI versus CT imaging for osteoid osteoma in children.

UNLABELLED: Advanced imaging often is obtained in children suspected of having osteoid osteoma. We hypothesized that magnetic resonance imaging gives a falsely aggressive appearance and that computed tomography is better for identifying osteoid osteoma. This is the first prospective blinded study comparatively assessing these imaging studies in children. Twelve preoperative magnetic resonance imaging scans of confirmed cases of osteoid osteoma were collected. Three radiologists blinded to the diagnosis reviewed these images. Only a clinical history of skeletal pain was given. Lesions were classified as benign-latent, benign-aggressive, or malignant. Radiologists were asked to list their primary diagnosis (with a confidence level from 1-10). Seven of these 12 children also had computed tomography scans that subsequently were reviewed in similar manner. With computed tomography scans, lesions were accurately identified as benign-latent (15/21 readings, 71%) and as osteoid osteoma (14/21 readings) more frequently than with magnetic resonance imaging scans (7/36 readings, 19%). LEVEL OF EVIDENCE: Diagnostic study, Level III-1 (study of nonconsecutive patients--no consistently applied reference gold standard). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2005

Case report: A rare case of Ewing's sarcoma and osteosarcoma at different sites 10 years apart.

Ewing's sarcoma of bone and osteosarcoma are rare tumors. A combination of high-grade osteosarcoma and Ewing's sarcoma of bone in anatomically unrelated sites is unique, especially in the absence of previous radiation or retinoblastoma. We present a patient with a rare case of Ewing's sarcoma of the scapula that showed no evidence of recurrence (after 10 years of continued followup) and who subsequently presented with a primary osteosarcoma of the femur.

Adult↗
PubMed2005

Recurrence and bleeding in hibernomas.

UNLABELLED: Hibernomas are rare, benign, soft tissue tumors of brown fat. Despite being benign, we have experienced recurrent hibernomas and cases of significant bleeding at our institution. The current literature contains case reports of recurrence, and one large series that describes pathologic variants but contains little clinical data. We could not find data on bleeding. We hypothesized that recurrence is related to the resection type and/or the pathologic variant. We also postulated that atypical histologic findings correlate with excessive bleeding during excision. We sought to confirm that the MRI features of hibernomas could distinguish them from lipomas yet place them among lipomatous tumors. We retrospectively reviewed all hibernomas at our institution over 10 years. There were six hibernomas. Two were removed with a marginal excision and four with an intralesional excision. Two recurred after intralesional surgery. Histologic findings were typical for all patients. An MRI was available on only one patient and showed a fatty tumor that was distinguishable from a lipoma. Recurrences occurred after intralesional but not after marginal excisions. Histology could not predict recurrence. Hibernomas have the potential for significant bleeding during surgical excision, as seen in two of our cases. LEVEL OF EVIDENCE: Prognostic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2005

Endoprosthetic reconstructions: results of long-term followup of 139 patients.

UNLABELLED: Our primary goal in doing this study was to determine the effect of prosthesis location, patient age, periprosthetic infection, and primary versus revision placement on endoprosthetic survival. We also examined our endoprosthetic survival rates and reasons for failure. We retrospectively studied 139 endoprosthetic reconstructions performed between 1984 and 2002, including 57 distal femur, 27 proximal femur, 26 proximal tibia, 17 proximal humerus, 4 distal humerus, 3 total scapula, 3 total femur, and 2 total humerus reconstructions. Location of reconstruction and presence of periprosthetic infection significantly affected endoprosthetic survival. Survival was not affected by patient age or primary versus revision placement. Overall, Kaplan-Meier event-free endoprosthetic survival was 86%, 80%, and 69% at 3, 5, and 10-year followup. The trend for endoprosthetic survival from best to worst was proximal femur, proximal humerus, distal femur, proximal tibia, and distal humerus. Reasons for failure included mechanical failure (eight patients), tumor recurrence (eight patients), aseptic loosening (six patients), dislocation (two patients), periprosthetic infection (two patients), and endoprosthetic malalignment (one patient). Our periprosthetic infection rate was 2.2%. The local recurrence rate in patients treated for primary malignant tumors was 6.8%, similar to previous limb-salvage and amputation studies. Overall, we have found that endoprosthetic reconstruction is a reliable limb-salvage technique. LEVEL OF EVIDENCE: Therapeutic study, Level IV-2 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2005

Intralesional curettage for grades II and III giant cell tumors of bone.

UNLABELLED: Grade III Campanacci lesions are traditionally treated with wide resections based on their postulated aggressiveness and potential for local recurrence and metastasis. The purpose of this study was to determine if there was a difference in local recurrence rates of Grade II and III lesions treated with intralesional curettage, burring, phenol cauterization, and polymethylmethacrylate application. Sixty-three patients (26 Campanacci Grade II and 37 Grade III lesions) met the inclusion criteria. No pathologic fractures, including intraarticular fractures, were included in this study. Followup averaged 108 months (range, 25-259 months). The overall local recurrence rate was 6% (4 of 63 patients), with no observed difference between Grade II and III lesions. The average Musculoskeletal Tumor Society functional score was 27.9/30 (93%). The mean range of motion of the adjacent joint was 97%. Patients with radiographic signs of osteoarthritis before treatment did not show substantial progression, and only one patient developed radiographic signs of degenerative arthritis postoperatively. Our distal metastatic rate was 3.2%. These data support the use of intralesional curettage and burring with adjuvant phenol and polymethylmethacrylate even in Grade III lesions, in the absence of pathologic fracture, regardless of the presence or extent of extraosseous extension. LEVEL OF EVIDENCE: Therapeutic study, Level III-1 (retrospective cohort). See the Guidelines for Authors for a complete description of levels of evidence.

Bone Neoplasms↗
PubMed2005

Traumatic atlanto-occipital dislocation in children.

BACKGROUND: Traumatic atlanto-occipital dislocation in children and adolescents is a rare and often fatal injury. Although historically most reported cases have been fatal, the advent of modern prehospital care has led to an increase in survival following this injury. As a consequence, some patients may achieve or maintain satisfactory neurologic function following early intervention, stabilization, and definitive management. We analyzed the data on children and adolescents in whom traumatic atlanto-occipital dislocation had been treated with modern resuscitation techniques at our institution. METHODS: Atlanto-occipital dislocation is defined as disruption of the ligaments and other supporting soft tissues as indicated by displacement in either a transverse or vertical direction. With use of the Trauma Registry database at our institution, we identified sixteen such injuries that had occurred between 1986 and 2003. The hospital charts, clinic notes, and radiographs were reviewed. A careful neurological evaluation was performed for all of the survivors at the time of the latest follow-up. RESULTS: The mean age of the sixteen patients at the time of the injury was 7.6 years. The mechanisms of injury were diverse. The mean Glasgow Coma Scale score was 7.4 points. Eleven of the sixteen patients underwent intubation in the field, two were intubated in the emergency department, and three were not intubated. Eight of the sixteen patients were declared dead on arrival in the emergency department. The eight surviving patients initially were immobilized with either a halo vest or another orthosis. All patients except one received intravenous steroids in the emergency department. Three of the patients who survived the initial injury subsequently died while undergoing neurosurgical procedures for the treatment of extensive intracranial injuries. Four of the remaining five survivors underwent occiput-C2 fusion, and one was managed with a Minerva cast. At the time of the final follow-up, at a mean of 4.2 years after the injury, one patient was neurologically normal, three had mild spastic hemiparesis and were very functional, and one had spastic quadriplegia and was ventilator-dependent. CONCLUSIONS: Prompt recognition and treatment of traumatic atlanto-occipital dislocation in children and adolescents can result in improved survival. Early diagnosis, prompt intubation, early and adequate immobilization of the head and neck, and the use of intravenous steroids appear to facilitate survival. We recommend arthrodesis from the occiput to C2 (or the nearest adjacent intact and stable vertebra caudad to C2) for all children who survive a traumatic atlanto-occipital dislocation, particularly those with an incomplete spinal cord injury.

Adolescent↗
PubMed2004

New technique in congenital scoliosis involving fixation to the pelvis after hemivertebra excision.

STUDY DESIGN: The authors conducted a retrospective study involving description of a new surgical technique. OBJECTIVES: The objective of this study was to describe and evaluate the efficacy of a new technique to stabilize the spine of young and small patients with congenital scoliosis after lumbosacral hemivertebra excision. SUMMARY OF BACKGROUND DATA: Congenital scoliosis develops as the result of anomalous vertebral development and asymmetric growth. The vertebral anomalies include congenital fusions and congenital hemivertebrae. With lumbosacral hemivertebrae at the lumbosacral junction, surgical excision followed by instrumentation to close the resulting space is frequently the best way to correct the deformity and obtain spinal balance. Surgical stabilization is required for preventing recurrent deformity and restoration of spinal balance. METHODS: A new surgical technique for spinal correction and stabilization in congenital scoliosis is described. The technique involves hemivertebra excision followed by fixation of the adjacent normal vertebra to the ilium with screws and cables. This technique allows efficient correction in both the coronal and sagittal planes. RESULTS: This construct was prospectively studied in 3 cases over a 3- to 5(1/2)-year period. All cases had solid fusion and well-balanced spine at latest follow up. CONCLUSIONS: This prospective study demonstrates a successful surgical technique for spinal stabilization after congenital hemivertebra excision in infants and young children with relatively small and soft bones when standard constructs like pedicle screws may not be optimal devices. Coronal and sagittal balance (restoration with improvement of lordosis) was successfully achieved in all cases.

Child↗