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Biomedical subjects

V L Fornasier

Publications and source records attributed to V L Fornasier.

At least 55 records · Page 3Linked to original sources
PubMed1989

Complications and functional results after limb-salvage surgery and radiotherapy for difficult mesenchymal neoplasms: a prospective analysis.

Wide resection with adjuvant radiotherapy is generally accepted as the optimal treatment for patients with extremity soft-tissue sarcomas. However, there is a subset of patients with "difficult" tumours who sustain such marked loss of function from limb-salvage procedures that amputation might offer a superior functional alternative. To evaluate this issue, the authors prospectively designated 19 of 52 patients registered in Toronto's Princess Margaret Hospital Prospective Sarcoma Database in 1986 as "difficult" cases, on the basis of tumour size and anatomical location. Complications and functional results of wide resection and adjuvant radiotherapy were documented. The most frequent complication was related to wound healing (8 of 19 patients). Functional analysis at 1 year follow-up demonstrated that all 19 patients had results superior to those that would be expected with amputation.

Adult↗
PubMed1989

The surgical margin in soft-tissue sarcoma.

In a retrospective review of 231 patients who were referred to Princess Margaret Hospital because of a soft-tissue sarcoma in an extremity, 100 patients were identified who had no metastases when they were first seen and who had been treated by local resection and adjuvant radiation therapy. Complete data were collected for each patient for the following variables: age; sex; location of the tumor and its size, grade, depth, and compartmental status; chemotherapy; and dose of radiation. The surgical margins were characterized as positive or negative for histological evidence of disease on the basis of an independent review of the pathological and operative reports by a surgeon and a radiation oncologist who were experienced in the management of sarcoma. Cox multivariate analysis was used to determine which of these variables contributed to local recurrence and evidence of systemic disease. Adequacy of the margin of resection was the only variable that was associated with local relapse (p = 0.0004). The size of the tumor (p = 0.0008) was the major determinant of the risk of systemic disease.

Adolescent↗
PubMed1988

The effects of bulk versus particulate ultra-high-molecular-weight polyethylene on bone.

Fourteen mature New Zealand white female rabbits underwent implantation of a bulk pellet and of particulate (less than 1,000 micron) ultra-high-molecular-weight polyethylene (UHMWPE), through a drill hole in the proximal right tibia. The left tibia served as a drilled but nonimplanted control. The rabbits were killed after 16 weeks. Histologic examination of the bone-implant interface in the bulk UHMWPE group disclosed a fibrous tissue membrane with infrequent giant cell and histiocytic clusters at surface irregularities. The particulate group demonstrated positively birefringent UHMWPE fragments, rimmed by foreign body giant cells and histiocytes, embedded in a loose connective tissue. The histologic response to particulate UHMWPE is similar to that seen surrounding loose total joint arthroplasties in humans.

Animals↗
PubMed1988

The effects of bulk versus particulate polymethylmethacrylate on bone.

Twenty-one mature New Zealand white female rabbits were allocated into three groups of seven rabbits. Group I received a bolus of doughy Simplex polymethylmethacrylate (PMMA) cement injected into the proximal tibia through a drill hole. Group II received a preformed, cooled, bulk PMMA pellet. Group III had particulate PMMA powder implanted. The operated, but nonimplanted, left tibiae served as controls. Animals were killed after four months. Histologically, both Group I and Group II demonstrated a thin, fibrous tissue membrane at the implant interface. Particulate PMMA (Group III) stimulated a much thicker, florid, foreign body reaction composed of histiocytes and giant cells. The foreign body response to particulate acrylic cement was similar to that seen in failed cemented joint replacement arthroplasty in humans.

Animals↗
PubMed1987

Wagner resurfacing arthroplasty of the canine hip.

Twelve surface replacement arthroplasties were performed on the hips of ten mongrel dogs using scaled-down replicas of the Wagner prosthesis. The contralateral hips and two further animals served as nonoperated controls. Animals were killed 5 months postoperatively. Clinical, radiological, histological and fluorochrome-labelling studies were employed to assess the bony and soft tissue reaction to resurfacing arthroplasty. There was no clinical or radiographic evidence of prosthetic loosening. Histological examination disclosed a thick foreign body and chronic inflammatory membrane containing acrylic cement and polyethylene wear particles at the bone-cement interface of both components. Generally, the bone marrow and trabecula were viable. There was evidence of increased bony remodelling and new bone formation in the subchondral area. The similarity between the above findings and those of aseptic component loosening in man suggests a mechanism whereby wear debris initiate a biological foreign body reaction culminating in component loosening.

Acetabulum↗
PubMed1987

Osteochondral disruption of the second metatarsal: a variant of Freiberg's infraction?

A case of Freiberg's Infraction of the second metatarsal is presented. The metatarsal head was resected and its pathology proved very informative. Necrotic bone was not found, but a shearing type of separation was identified at the level of "tidewater mark" in the articular cartilage and was the major observation. This suggested the possibility that in adults Freiberg's Infraction rather than true avascular necrosis may be in fact the result of a shearing-compression type of injury occurring at the interface between mineralized and nonmineralized articular cartilage (tidewater mark). An anatomical examination of metatarsophalangeal joints in cadavers showed that during walking at the "toe off" position, the toes dorsiflex to force the metatarsal head into plantar flexion. The proximal phalanges ride dorsally over the metatarsal heads producing a shearing force that would support our interpretation of the observations made in the case presented.

Ankle Injuries↗
PubMed1986

Case report 398.

Explore the source record for details and available documents.

Adult↗
PubMed1986

Percutaneous bone marrow grafting of fractures and bony defects. An experimental study in rabbits.

Since bone marrow has been shown to contain osteoprogenitor cells, an experiment was devised to test its effects when injected percutaneously into osteotomies and 2-cm bony defects produced in rabbit radii. The parameters tested included callus volume, breaking load, tensile strength, and cross-sectional area of callus at the fracture or bony defect site. At two weeks postgrafting callus volume was significantly higher (p less than 0.01) in the grafted radii than in the contralateral saline controls. By four weeks all four parameters were significantly greater in the bone marrow grafted radii than in the contralateral saline controls. Serial radiographs and histology confirm this advanced fracture healing in the grafted bones. The earlier and more abundant callus, at the bone marrow grafted sites, was felt to provide earlier and greater stability, resulting in decreased early healing time when contrasted with the saline controls. Similarly, the bony defects that were grafted with bone marrow united by a bony bridge, whereas the saline controls did not. Percutaneous bone marrow grafting is a simple semi-invasive technique that may have potential clinical applications.

Animals↗
PubMed1986

Early diagnosis of osteonecrosis in systemic lupus erythematosus with magnetic resonance imaging. Failure of core decompression.

A 42-year-old white male with systemic lupus erythematosus developed radiologically evident left femoral head osteonecrosis. Magnetic resonance imaging showed evidence of bilateral disease, including the asymptomatic right femoral head. Despite early surgical decompression of the latter lesion, there was rapid progression requiring total hip joint replacement.

Adult↗
PubMed1985

The effect of polymethylmethacrylate on bone: an experimental study.

In order to assess the response of bone to low-viscosity polymethylmethacrylate, CMW or Simplex acrylic cement was digitally packed while in a doughy state into drill holes in the proximal diaphysis in each of four long bones (humeri and tibiae) of mongrel dogs. Histological assessment was performed in areas of minimal load at the interface between the viscoelastic bone and the acrylic cement. Decalcified and undecalcified sections were evaluated and a remodeling or activity index calculated. Fluorescent labeling studies were performed in order to assess bone growth. Animals were killed at 2, 4 or 5 months. Histological analysis showed a thin connective-tissue membrane containing scattered giant cells and histiocytes at the bone-cement interface. Inflammation was not an important facet of this response. The marrow and trabecular bone were viable, except for scattered localized areas of marrow necrosis and fibrosis immediately adjacent to the cement. The bone adjacent to the cement showed a lower remodeling or activity index, fewer fluorescent bands, and smaller distances between successive bands, suggesting decreased bone formation and turnover. The etiology of these findings may include a vascular disturbance secondary to disruption of the cortical and marrow circulation, temperature effects during cement polymerization, and/or chemical effects from the acrylic monomer.

Animals↗
PubMed1985

A study of implant failure in the Wagner resurfacing arthroplasty.

Using clinical, radiographic, and pathological data, we investigated eighteen cases of early aseptic failure of an implant in patients who had undergone reconstruction of the hip with a Wagner resurfacing prosthesis. Sixteen patients required revision for loosening of the acetabular component, with eight of them also demonstrating loosening of the femoral component. One patient had loosening of the femoral component without failure of the acetabular component, and one patient sustained a femoral neck fracture that was associated with osteonecrosis. Six of the patients with loosening of the acetabular component had an associated significant loss of acetabular bone stock. Loosening was associated with the development of a membrane at the bone-cement interface in all patients. Histological examination of the membrane demonstrated a marked foreign-body response to wear products from the arthroplasty. Bone resorption appeared active at the bone-membrane interface. We concluded that the acetabular component of the Wagner prosthesis is prone to early loosening and that the early loosening is potentiated by a foreign-body response to debris resulting from arthroplastic wear.

Acetabulum↗
PubMed1984

Ollier's disease with multiple sarcomatous transformations.

A 53-year-old man had the monomelic form of Ollier's disease, which resulted in deformity of the left leg. The patient was otherwise well until pain and increasing size of the left thigh led him to seek treatment. Biopsy revealed chondrosarcomatous transformation in the distal left femur. Hip disarticulation was performed. This case is unusual in that multiple foci of chondrosarcomatous transformation at various stages of development were present throughout the left femur, tibia, and fibula.

Amputation, Surgical↗
PubMed1983

Leiomyosarcoma in bone: primary or secondary? A case report and review of the literature.

Our case demonstrates how metastases may be present and symptomatic long before they produce sufficient osseous changes to render the lesions radiologically detectable. A case of leiomyosarcoma arising in the uterus and initially presenting as a femoral lesion is presented. It required an intensive review of the case history and of the previous pathology in order to identify the primary site in the uterus. In the literature nine cases of metastatic leiomyosarcoma presenting initially in bone are reviewed. Ten additional cases from the literature showed bone metastases as the first site of recurrence. When this is assessed together with some 14 cases of primary leiomyosarcomas reported arising in bone, one is impressed that this is an uncommon tumour in bone either as a primary or secondary. In all patients in whom a leiomyosarcoma is histologically proven in bone, all primary sites should be specifically and categorically excluded before the lesion is accepted as an osseous primary. This should include special stains for myofibrils and electron microscopy if at all possible, in order to differentiate such tumours from other sarcomas such as fibrosarcoma. This applies especially to patients with uterine lesions that have been previously treated, even if they have been regarded as benign initially. All previous pathology and in particular hysterectomy specimens should be carefully reviewed. The need to specifically identify a leiomyosarcoma as a primary lies in the different modalities of treatment used: aggressive ablative surgery for primary lesions as opposed to radiation and chemotherapy for metastatic disease.

Bone Neoplasms↗
PubMed1983

Supervoltage radiotherapy in the treatment of difficult giant cell tumors of bone.

Fifteen patients with giant cell tumor were treated by supervoltage radiotherapy. Each patient had been referred for therapy because adequate surgery would have been difficult or disfiguring. No patient who received appropriate therapy experienced a recurrence, and there were no cases of malignant transformation of a giant cell tumor after a mean follow-up period of 12 years. Radiotherapy is not recommended for primary treatment of giant cell tumor but may be indicated in exceptional circumstances.

Adolescent↗