Biomedical subjects
Publications and source records attributed to R M Wilkins.
Metastatic involvement of the femur is a common clinical problem and accounts for the third highest incidence after the spine and pelvis. These patients are confronted with the possibility of losing the ability to ambulate during their remaining months. However, with improved prosthetic implants and internal fixation devices, most patients can resume their previous activities after operative treatment of their femoral fractures.
Giant cell tumor, a relatively rare, occasionally malignant tumor of bone, remains a difficult therapeutic problem for the orthopedic surgeon. Various treatment options, including curettage alone, curettage with bone grafting, radiation, and curettage with acrylic cementation have been utilized and reported. Therapeutic complications such as infection, recurrence, and loss of support of the articular surface have continued to plague the treatment of giant cell tumors. This article reports the results of 10 consecutive cases of giant cell tumor of bone treated by curettage and methyl methacrylate cementation, followed by bone grafting of the surface of the lesion with demineralized bone matrix to reconstitute the cortex at the site of the tumor. At an average follow up of 36 months, eight patients had an excellent functional result and two had a fair result as scored on the Musculoskeletal Tumor Society rating system. To date, there have been no tumor recurrences or metastases, and all patients have radiographic evidence of healing of the weight bearing cortical surface.
Canine osteosarcoma bears striking resemblance to osteosarcoma in humans. Similarities include the following: male sex predilection, large patient size, 75% or more affecting the appendicular site, metaphyseal location, generally unknown etiology, less than 10% of patients have documented metastasis at presentation, over 90% of tumors show high-grade histology, 75% of tumors show aneuploidy, the metastatic rate is 80% or more with amputation alone, the lung is the most common site of metastasis, and there is improved survival with adjuvant chemotherapy. The major differences are age of onset, with dogs being affected in middle age; greater frequency in the dog, with over 8000 new cases per year; and time to metastasis being faster in the dog than man. Canine osteosarcoma is a readily available and highly comparable spontaneously occurring cancer that should be useful in a better understanding of the same disease in humans.
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The records of 140 patients with histologically verified Ewing's sarcoma of bone treated between 1969 and 1982 were studied retrospectively. Various factors thought to be relevant to prognosis were analyzed. Three statistically significant factors were found: presence of metastatic disease, elevation of the sedimentation rate, and location of the tumor in the pelvis. In addition, patients who underwent complete surgical excision of the primary lesion had a better survival rate (74% at 5 years) than those who did not (34% at 5 years). It is concluded that patients with surgically accessible lesions should undergo treatment consisting of surgery, chemotherapy, and, in selected cases, radiation.
A patient with a lymph cyst of the thigh following sulfuric acid burns of both feet is presented. It was diagnosed by percutaneous lymphangiography with Ethiodal. Omentopexy was performed with success. A complication of hernia of small intestine into the thigh was corrected by herniorraphy. Omentopexy is an excellent modality to improve lymph flow. Awareness of hernia post operatively may limit its use.
Advances in adjuvant chemotherapy and improvements in techniques of oncologic reconstruction have stimulated renewed interest in limb saving operation for malignant bone tumors. Between 1970 and 1981, 160 patients underwent local resection for malignant osseous lesions at the Mayo Clinic. This included 102 patients with chondrosarcoma, 44 with osteosarcoma, and 14 with fibrosarcoma. Ninety-three of the lesions were stage I and 67 were stage II. The overall local recurrence rate was 11.8%. The reconstructive procedures were effective in providing adequate functional restoration. Limb sparing operation is a valid viable option in carefully selected patients with malignant bone tumors. A continued search for effective adjuvant treatment programs is necessary.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.