Biomedical subjects

J Sybil Biermann

Publications and source records attributed to J Sybil Biermann.

26 records · Page 2Linked to original sources

PubMed2002

American Society of Clinical Oncology clinical practice guidelines: the role of bisphosphonates in multiple myeloma.

PURPOSE: To determine clinical practice guidelines for the use of bisphosphonates in the prevention and treatment of lytic bone disease in multiple myeloma and to determine their respective role relative to other conventional therapies for this condition. METHODS: An expert multidisciplinary Panel reviewed pertinent information from the published literature through January 2002. Values for levels of evidence and grade of recommendation were assigned by expert reviewers and approved by the Panel. Expert consensus was used if there were insufficient published data. The Panel addressed which patients to treat and when to treat them in the course of their disease. Additionally, specific drug delivery issues, duration of therapy, initiation of treatment and management of treatment of lytic bone disease was reviewed and compared with other forms of therapy for lytic bone lesions. Finally, the Panel discussed patient and physician expectations associated with this therapy for bony metastases, as well as public policy implications related to the use of bisphosphonates. The guidelines underwent external review by selected physicians, by the Health Services Research Committee members, and by the ASCO Board of Directors. RESULTS: The available evidence involving randomized controlled trials is modest but supports that oral clodronate, intravenous pamidronate, and intravenous zoledronic acid are superior to placebo in reducing skeletal complications. A reduction in vertebral fractures has consistently been seen across all studies. No agent has shown a definitive survival benefit. Intravenous zoledronic acid has recently been shown to be as effective as intravenous pamidronate. Because there are no direct comparisons between clodronate and pamidronate or zoledronic acid, the superiority of one agent cannot be definitively established. However, the panel recommends only intravenous pamidronate or zoledronic acid in light of the use of the time to first skeletal event as the primary end point and more complete assessment of bony complications in studies evaluating it. Additionally, clodronate is not available in the United States. The choice between pamidronate and zoledronic acid will depend on choosing between the higher drug cost of zoledronic acid, with its shorter, more convenient infusion time (15 minutes), versus the less expensive drug, pamidronate, with its longer infusion time (2 hours). CONCLUSION: Bisphosphonates provide a meaningful supportive benefit to multiple myeloma patients with lytic bone disease. However, further research on bisphosphonates is warranted, including the following: (1) when to start and stop therapy, (2) how to integrate their use with other treatments for lytic bone disease, (3) how to evaluate their role in myeloma patients without lytic bone involvement, (4) how to distinguish between symptomatic and asymptomatic bony events, and (5) how to better determine their cost-benefit consequence.

Clodronic Acid↗

PubMed2002

Calcific tendinitis of the gluteus medius tendon with bone marrow edema mimicking metastatic disease.

A case of calcific tendinitis of the gluteus medius is presented. This report describes a patient with a history of breast cancer who had the combination of amorphous calcifications in the gluteus medius tendon and the MR finding of conspicuous bone marrow edema in the adjacent greater trochanter, prompting concern for metastatic disease. We present images from radiography, bone scanning, CT, and MR imaging. The unusual combination of findings in these studies should be considered conclusive for calcific tendinitis, and should not be confused with malignancy.

Bone Marrow Diseases↗

PubMed2002

Melanoma information on the Internet: often incomplete--a public health opportunity?

PURPOSE: To assess the accuracy and completeness of information regarding melanoma on the Internet, retrieved by use of search engines. METHODS: The first 30 uniform/universal resource locators (URLs) from each of eight search engines using the search term "melanoma" were retrieved for evaluation of accuracy and completeness using a 35-point checklist rating system instrument. Four reviewers independently rated each of 35 sites, and one reviewer rated all 74 assessable sites. Kappa statistics were used to evaluate interrater variability. RESULTS: A total of 74 assessable Web sites were evaluated. The remainder were inaccessible, link pages only, or duplicates. Thirty-five Web sites were each independently rated by four reviewers. The remaining 39 Web sites were each rated by one reviewer. The mean kappa statistic for all variables and all rater pairs for which a kappa could be calculated was 0.824, indicating excellent overall inter-rater reliability. The majority of Web sites failed to include complete information on general information, risk factors, diagnosis, treatment, prevention, and prognosis. Ten Web sites (14%) contained a total of 13 inaccuracies, most relatively minor. CONCLUSION: Medical information retrieved with the search term melanoma was likely to lack complete basic melanoma information and contained inaccuracies in 14% of sites. Health care providers can help patients by recommending comprehensive and accurate Web sites for patient review, by working to create accurate and thorough Web-based health information material, and by educating patients and the public about the variability in completeness and accuracy.

Humans↗

PubMed2002

Absence of HER2/neu gene expression in osteosarcoma and skeletal Ewing's sarcoma.

PURPOSE: Osteosarcoma (OS) and skeletal Ewing's sarcoma (EWS), the most common pediatric primary bone tumors, are aggressive malignancies with a tendency for early pulmonary metastasis. Advances in therapy have increased the overall 5-year survival to approximately 70%; however, patients who relapse often fail to respond to salvage therapy. Thus, more effective adjuvant chemotherapy is needed for these patients. Several reports have claimed expression of the HER2/neu (c-erbB-2) gene in a high percentage of OSs and that its expression is a poor prognostic factor and have advocated monoclonal antibody therapy in those cases. EXPERIMENTAL DESIGN AND RESULTS: To validate the expression of HER2/neu in these tumors, archival cases of OS (n = 66) and EWS (n = 11) from 44 patients were assessed for HER2/neu gene expression by immunohistochemistry (DAKO rabbit polyclonal antibody A0485). Thirty-four cases (44%) demonstrated granular cytoplasmic staining, but none showed the distinct membranous staining characteristic of expression exhibited by breast carcinomas. To validate these immunohistochemical results, reverse transcription-PCR using RNA derived from archival material (n = 48) and several different primer pairs also failed to demonstrate the presence of amplifiable HER2/neu mRNA, although a known HER2/neu-positive breast carcinoma showed amplifiable mRNA. CONCLUSIONS: Thus, in contrast to previous reports, our results demonstrate an absence of HER2/neu expression in OSs and EWSs. Our results show that HER2/neu is not expressed by these sarcomas, and we conclude that HER2/neu is therefore not an important prognostic factor and that anti-HER2/neu monoclonal antibody therapy is not appropriate for these patients.

Adolescent↗

PubMed2002

Patient Internet use in a community outpatient orthopaedic practice.

This study evaluated Internet use among orthopaedic patients in a private practice general orthopaedic setting. Of 154 respondents, twenty percent had used the Internet to research their orthopaedic diagnosis. Search rates were lowest for patients with arthritis and highest for patients with disorders of the spine or back. Seventy percent of these patients who had searched had found their searches helpful, and over 50% of patients who had searched had questions raised that they planned to address with their physicians. Of those patients who did search the Internet, none reported concern regarding the credibility of Internet retrieved material.

Adolescent↗

PubMed2002

Intraosseous lipoma of the proximal radius with extraosseous extension and a secondary posterior interosseous nerve palsy.

We describe an unusual and previously unreported case of a histologically verified solitary intraosseous lipoma of the proximal radius with extraosseous tumor extension and a secondary posterior interosseous nerve palsy. A successful outcome was achieved after intralesional resection of the soft-tissue tumor extension, curettage of the proximal radius, autogenous cancellous bone grafting of the resultant intramedullary defect, and tendon transfers.

Aged↗

PubMedDate not supplied

Use of the Internet by pediatric orthopaedic outpatients.

The Internet is a rich source of medical information, but little is known about orthopaedic patients' use of the Internet for medical information. Adults accompanying children to the clinic of a pediatric orthopaedist were surveyed regarding their rates of access to and use of the Internet for orthopaedic information and their opinions about the success of their searches and the utility of the Internet as a source of medical information. The response rate was 84% (212/253). Search rates were lowest for patients with fractures (18.2%) and highest for patients with scoliosis (53.5%). Slightly more than three quarters found their search helpful, and slightly less than half planned to discuss their search with the physician. Use of the Internet by patients and family members can create additional time demands on the orthopaedist with questions resulting from their search. Physicians can minimize time demands and educate their patients by guiding them to reputable, patient-oriented Internet sites and taking part in the creation of such sites.

Fractures, Bone↗

PubMedDate not supplied

Common benign lesions of bone in children and adolescents.

Although benign bone neoplasms are relatively uncommon in children and adolescents, their discovery can produce great angst among providers and parents. In most but not all instances, imaging studies can indicate the likely benign nature of the tumor and allay fears. The clinical presentation, imaging, and contemporary management of five common types of tumor or tumor-like conditions of bone commonly seen in children and adolescents are reviewed: nonossifying fibroma, unicameral bone cyst, aneurysmal bone cyst, fibrous dysplasia, and exostosis.

Bone Cysts↗