Biomedical subjects

Jeffrey S Kneisl

Publications and source records attributed to Jeffrey S Kneisl.

5 recordsLinked to original sources

PubMed2006

Is PET useful in detecting occult nonpulmonary metastases in pediatric bone sarcomas?

UNLABELLED: Orthopaedic oncologists are increasingly utilizing positron emission tomography (PET) technology in the initial workup and staging of sarcomas and for monitoring treatment response. We evaluated the use of PET with fluorine-18-fluoro-2-deoxy D-glucose (FDG) to detect occult nonpulmonary metastases in patients < age 30 newly diagnosed with either Ewing's or osteosarcoma, and the impact of this information upon therapeutic decision making. We retrospectively reviewed prospectively collected data (1994-2004) on 55 patients age < 30 years old over a 10 year span. PET detected metastases in 12/55 (22%) of these patients, eight of whom (67%) harbored disease outside the lung; however, only 4/55 (7%) were upstaged to Stage IV specifically due to findings determined by PET alone. Three of 17 (18%) Ewing's sarcoma patients, but only one of 38 (3%) osteosarcoma patients, were upstaged by PET alone. The most important alteration in treatment decisions was the substitution of irradiation in lieu of surgery for local control in Ewing's sarcoma patients. LEVEL OF EVIDENCE: Diagnostic study, level II.

Adolescent↗

PubMed2004

Informed consent is not routinely documented for procedures using allografts.

Patients who receive musculoskeletal allografts may have severe postoperative infections develop. Media reports have heightened public awareness of the risk of allograft use. Explaining these risks to patients preoperatively has become more important as attention to informed consent issues has increased. This study retrospectively investigated the patterns of informed consent for allograft bone used during elective orthopaedic procedures at a major teaching hospital. Forty-seven (32%) of 148 patients had preoperative discussions of allograft risks and benefits documented with a signed preoperative consent. In nearly 70% of the cases in which structural allograft was used, preoperative consent was documented. Only 8% of cases in which nonstructural, highly processed allograft was used had documented preoperative consent. Forty-eight (32%) of 148 patients were treated with allograft and autograft. Consent was obtained for the harvesting and use of autograft from 90% of these patients. In none of these patients was consent obtained for the allograft used. Although risks of disease transmission vary widely with the degree of allograft processing and the source of its procurement, informed consent for any allograft use should be a routine part of preoperative discussions of risks and benefits in elective orthopaedic surgeries.

Bone Transplantation↗

PubMed2003

Biomechanical effects of processing bulk allograft bone with negative-pressure washing.

The best method for processing allograft bone to prevent disease transmission without compromising its biomechanical function is not yet determined. We evaluated the biomechanical effects of processing bulk allograft bone segments with negative-pressure washing. Specimens were prepared from matched pairs of adult cadaveric femurs. The experimental femur underwent routine processing, followed by negative-pressure washing, whereas its matched control underwent routine processing only. Each specimen was tested to failure, and maximal stress values were determined. No differences were found in yield stress comparisons between groups for the following specimens and tests: compression of machined femoral heads, screw push-out testing in cortical bone, and 4-point bending of cortical beams. Compression testing of diaphyseal ring struts provided varied results. Negative-pressure-washed half-ring strut grafts were statistically stronger (9.6%) than their matched controls (P = 0.018). Negative-pressure-washed full-ring strut grafts were statistically less strong (-12.2%) than their control counterparts (P = 0.003). We studied 5 different allograft types (designed with clinically relevant geometries) subjected to 3 modes of testing (representative of loading in typical clinical situations). Our data show that processing of large, essentially intact allograft bone segments with negative-pressure washing had little, if any, biomechanical effect relative to frozen controls.

Biomechanical Phenomena↗

PubMed2002

Incidental neoplasm in iliac crest autograft procured for anterior cervical fusion.

STUDY DESIGN: A case report is presented. OBJECTIVE: To present a previously unreported complication of procuring anterior iliac crest autograft. SUMMARY OF BACKGROUND DATA: Many complications that involve the common procedure of procuring iliac crest autograft have been reported and studied. The incidental finding of a neoplasm in an iliac crest autograft in an otherwise asymptomatic patient has not been reported previously. METHODS: A case of benign fibrous histiocytoma is presented as it was found incidentally during the procurement of the anterior iliac crest for anterior cervical fusion. Intraoperative decision making and alternatives for this challenging situation are reviewed. RESULTS: An iliac crest bone graft with a grossly unusual appearance was noted at the time of autograft procurement. The autograft was aborted, and an iliac crest allograft was substituted for the autograft to complete the planned cervical fusion. The lesion was later identified histopathologically and clinically as a benign fibrous histiocytoma. Postoperative computed tomography demonstrated the extent of the lesion. CONCLUSIONS: The intraoperative finding of a bony neoplasm at a planned autograft donor site in an otherwise healthy patient supports routine preoperative discussion of allograft alternatives. All patients undergoing surgery in which autograft is to be used should be informed regarding the possibility of allograft substitution. When a neoplasm is encountered unexpectedly, oncologic principles of obtaining frozen section or a touch-prep for diagnosis, avoiding the use of suspect graft material as well as cross-contamination of iliac crest and anterior cervical surgical sites, should be applied. Care should be taken intraoperatively with potentially contaminated drapes and instruments.

Bone Neoplasms↗

PubMedDate not supplied

Bone marrow sampling in pathologic fractures: intramedullary pediatric chest tube technique.

The objective of this article is to report upon a simple technique of bone marrow specimen collection of intramedullary bone tumors using a pediatric chest tube. This technique is described along with two case reports which include a 60-year-old female with metastatic breast cancer to the proximal femur, and a 63-year-old male with multiple myeloma of the proximal humerus. Utilizing this technique, in our experience, over 50 mL of aspirate can be obtained and definitive histologic material for cytogenetic diagnosis and immunohistochemistry. This technique is not indicated for biopsy of suspected primary lesions of bone due to the possibility of medullary or hematologic seeding and inappropriate invasion of soft tissue compartments.

Biopsy, Needle↗