Biomedical subjects
J A Murray
Publications and source records attributed to J A Murray.
Arterial occlusion of pelvic bone tumors.
Arterial occlusion of the internal iliac artery was successful in the relief of pain due to primary and secondary neoplasms of the bony pelvis in 8 of 9 patients. These included 3 giant cell tumors, 1 aneurysmal bone cyst, 1 recurrent chondrosarcoma, 3 metastatic renal cell carcinoma and 1 metastatic clear cell sarcoma. Calcification of the margin of the lesion occurred in 3 of 4 primary neoplasms after infarction. The transcatheter arterial occlusion was accomplished utilizing Gelfoam and stainless steel coils. Although most patients experienced pain and fever for several days following the procedure, no permanent sequelae or complications were encountered.
The value of percutaneous needle biopsy in the management of primary bone tumors.
Thirty-four suspected primary bone neoplasms were evaluated by needle biopsy at M. D. Anderson Hospital and Tumor Institute between September 1976 and February 1978. Adequate material for evaluation was obtained in 31 cases. The accuracy rate of the procedure was 93%. Needle biopsy is a rapid, effective and safe method of evaluating unsuspected primary lesions of bone. The indications, contraindications, and technique are emphasized. The benefits over open biopsy are indicated.
Management and results of localized Ewing's sarcoma.
Seventy-six patients with localized Ewing's sarcoma who received primary treatment at M.D. Anderson Hospital from 1948 through December 1975 were reviewed. Patients have been divided into four groups according to the different treatment regimens they received: Group I, moderate dose radiotherapy alone; Group II, high dose radiotherapy alone; Group III, radiotherapy plus vincristine and cytoxan; and Group IV, radiotherapy plus vincristine, Adriamycin, cytoxan and actinomycin. The problem of local recurrence appears to be solved with combined chemotherapy and radiation therapy with only one of 36 patients having a recurrence at the primary site in Groups III and IV. Multimodal therapy is the preferred treatment to obtain control of the primary lesion by radiation therapy while preserving good function. However, the major cause of failure remains distant metastases, 19 of 36 (53%) in Groups III and IV. In addition, 4 of 10 patients who have survived over 5 years have developed osteogenic sarcoma.
Angiography in giant-cell bone tumors.
Angiography was performed on 48 patients with giant-cell bone tumors. Sixty-four per cent were hypervascular; 25% were hypo- or moderately vascular; and 10% were avascular. Findings were similar in the 45 benign and 3 malignant tumors. There was no correlation between the findings and degree of histological aggressiveness. There was a high (60%) incidence of aneurysmal bone cyst component in the hypovascular group. Hyperemic synovium, occasionally simulating tumor, was seen in 80% of surgically proved lesions. Angiography was useful in assessing tumor extent, particularly when an extraosseous component was present.
Computed tomography in the evaluation of osteosarcoma: experience with 25 cases.
Experience with computed tomography (CT) in 25 patients with histologically proven osteosarcoma is presented. CT was as accurate as conventional radiographic methods in determining the presence of a lesion, but it was definitely superior in defining the extent of disease, particularly intramedullary extension and soft tissue extraosseous tumor component. CT was capable of demonstrating skip metastases in one patient. CT plays a key role in the preoperative evaluation of osteosarcoma patients, particularly when less than radical surgery is planned as primary treatment and when postoperative recurrence is suspected. CT is also useful in assessing the response to therapy in nonsurgical cases. The technique involved in the performance of this examination is discussed.
Multiple gastrointestinal volvulus.
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The radiographic spectrum of periosteal osteosarcoma.
Fifteen cases of a recently described variety of osteosarcoma, periosteal osteosarcoma, were studied to define their radiographic characteristics. All the lesions were limited to the cortex that was always thickened but without invasion of the medulla cavity. The tumors presented as non-homogeneous masses of spiculated osteoid matrix progressively denser from the periphery to their cortical base. The average age was 28 and the most common location was the proximal third of the femur; all the lesions were diaphyseal in location. The spectrum of radiographic features and differential diagnosis are described in detail.
Computed tomography in the evaluation of musculoskeletal neoplasms.
In a study of 62 musculoskeletal neoplasms, computed tomography contributed little to establishing tissue diagnosis. Its primary value lay in the assessment of intraosseous and/or extraosseous extent of disease. CT also established the presence or absence of disease in a small number of cases with clinically questionable findings. In most cases, conventional radiographic methods were superior in diagnosing musculoskeletal neoplasms.
Radiographic aspects of massive bone osteoarticular allograft transplantation.
Experience with 56 cases of osteoarticular allograft transplantation of the extremities is presented. Cadaveric allograft including a joint surface and a variable amount of shaft is used in the treatment of aggressive benign and low-grade malignant tumors involving a long bone near a joint. The preoperative radiographic evaluation is outlined. Thirty-four patients had an uncomplicated course. Twenty-two patients had complications including aseptic fracture, infection, and tumor recurrence. The radiographic spectrum of both complicated and uncomplicated cases is illustrated.
Percutaneous needle biopsy of bone in the cancer patient.
Needle biopsy of skeletal lesions is easily accomplished by the percutaneous technique. Although this approach has been utilized for many years, the frequency has definitely increased of the 91 cases performed at M. D. Anderson Hospital and Tumor Institute from September 1976 to September 1977, adequate material was obtained in 92.3% of the patients, and the diagnosis was established accurately in 83.5% of the cases. No complications were encountered. The technique, indications, and contraindications are discussed and illustrated with representative cases. The contribution of this technique to the management of patients with malignant disease is significant. The benefits include rapid and accurate establishment of a tissue diagnosis, avoidance of a surgical procedure with its associated risks and cost, and simplicity and safety of the procedure facilitating its repetition if needed.
Osteogenic sarcoma after the age of 50: a radiographic evaluation.
Twenty-four cases of primary osteosarcoma in individuals over the age of 50 are described. This represents 6% of all osteosarcomas and 80% of osteosarcomas occurring over the age of 50 at this institution. Radiographically, features were similar to osteosarcoma in younger individuals. Females were more frequently affected than males (2.4:1). The radiographic features are discussed in detail, and the differential diagnosis outlined.
Effect of aortocoronary saphenous vein bypass grafting on death and sudden death. Comparison of nonrandomized medically and surgically treated cohorts with comparable coronary disease and left ventricular function.
The effect of saphenous vein bypass grafting on the incidence of sudden cardiac death and total cardiovascular death was studied by comparing the survival of subsets of surgically and medically treated patients with coronary disease who were similar in two major prognostic variables: extent of coronary disease and ejection fraction. Significant differences in some baseline variables existed between medical and surgical subgroups with similar ejection fraction and extent of coronary disease. Medically treated patients tended to be in a lower functional class, to have more extensive ventricular contraction abnormalities, to have a larger end-diastolic volume, and to have fewer distal vessels feasible for grafting. Surgically treated patients with two vessel disease and normal or moderately reduced election fraction had improved survival when compared with medically treated patients with two vessel disease and similar ejection fraction. Improved survival of borderline statistical significance was also seen in surgically treated patients with three vessel disease and moderately reduced ejection fraction. When categorized according to end-diastolic volume, surgically treated patients with two vessel disease and normal or moderately increased end-diastolic volume also had improved survival over similarly defined medically treated patients. The sudden death rates for subgroups of mecically treated patients were 1.8 to 10.9 times higher than the rates in subgroups of surgically treated patients with a comparable extent of coronary disease and ejection fraction.
A critical look at guidelines for cardiac catheterization laboratories.
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Improvement in exercise performance after unsuccessful myocardial revascularization.
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Ocular lesions in cats with GM1-gangliosidosis with visceral involvement.
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Variability in the analysis of coronary arteriograms.
Variability in coronary arteriogram readings was studied by having cine films from ten patients read by eleven readers. Three of the eleven subsequently met as an expert panel to provide a joint evaluation which could serve as a standard. Considerable variability was found between individual readers and between readers and the panel. The average standard deviation for estimation of any segmental stenosis by any single reader was 18%. Disagreement about the number of major vessels with a 70% stenosis occurred 31% of the time. Discrepancies were most likely to occur in analyzing distal arterial segments, in reading nonopacified segments, and during analysis of films showing more severe disease or having poorer technical quality. Recent experience in reading arteriograms seemed to be the most important characteristic in determining the accuracy of a reader. A protocol for the use of three readers is suggested.
Myocardial imaging with thallium-201 at rest and during exercise. Comparison with coronary arteriography and resting and stress electrocardiography.
Myocardial imaging with intravenous thallium-201 (201Tl) was performed at rest and following maximal treadmill exercise in 101 patients with suspected coronary artery disease. Results were interpreted from Polaroid scintiphotos by three independent observers with complete interobserver agreement in 79%. Of 25 patients with no or insignificant coronary artery disease (less than 50% diameter stenosis), one (4%) had a resting 201Tl image defect, one (4%) had an exercise 201Tl defect, none had an ECG Q wave, and four (16%) had exercise ST-segment depression. Among 76 patients with coronary artery disease (greater than or equal to 50% diameter stenosis), 58 (76%) had a defect on either the rest or exercise 201Tl image. The proportion of patients with an exercise image defect (50/76, 66%) was greater than the proportion with exercise ST depression alone (34/76, 45%; P less than 0.02). Overall, 69 of the 76 (91%) patients with coronary artery disease had either a positive rest or exercise myocardial image and/or a positive rest (ECG Q waves) or exercise (ST depression) electrocardiogram. This exceeded the proportion with only rest or exercise electrocardiographic abnormalities (50/76, 65%; P less than 0.001). We conclude that rest and exercise myocardial imaging with 201Tl is easily accomplished with readily available imaging equipment. The image data enhanced the diagnostic sensitivity of stress electrocardiography, and provided spatial identification of the abnormal segment(s) of myocardium.