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Biomedical subjects

W Mnaymneh

Publications and source records attributed to W Mnaymneh.

At least 19 recordsLinked to original sources
PubMed1994

Massive distal femoral osteoarticular allografts after resection of bone tumors.

Records were reviewed for 96 patients who received distal femoral osteoarticular allografts to reconstruct femurs after wide resections of benign and malignant bone tumors. Thirteen of these were excluded from the study because of death or local recurrence. The mortality rate for all patients was 11%; for those with osteosarcomas it was 27%. The local recurrence rate was 3%. Eighty-three patients were subjected to further analysis. Their complications included fractures (14%), nonunions (12%), arthritis (10%), instability (7%), infections (6%), and resorption (6%). There was a significant difference in nonunion and infection rates between patients who received chemotherapy and those who did not. In the chemotherapy group, the infection rate was 13% versus 2% in the non-chemotherapy group. Nonunion rates were 23% versus 6% respectively. The differences in all other complication rates were not statistically significant. In patients not receiving chemotherapy (n = 53), final results were good or excellent in 70%, fair in 26%, and poor in 4%. In patients receiving chemotherapy (n = 30), final results were good or excellent in 53%, fair in 37%, and poor in 10%.

Adolescent↗
PubMed1994

Cryopreservation of articular cartilage. Ultrastructural observations and long-term results of experimental distal femoral transplantation.

Ultrastructural changes associated with the freeze-preservation of human articular cartilage have been investigated and related to changes in transplanted distal femoral allografts in nonhuman primates. Human osteoarticular specimens were frozen at 2 degrees/minute in the presence of 15% glycerol and kept in liquid nitrogen freezers (vapor phase) from one day to two years. Ultrastructural changes were confined primarily to chondrocytes and were related to the freezing phenomenon, not to the time of storage. The cartilage matrix was affected little, explaining why articular cartilage initially survives clinical transplantation, but later undergoes degenerative changes. Osteoarticular allografts of baboons were frozen in an identical fashion to the human articular cartilage and transplanted into adult baboons. Long-term observations (five years) on these animals showed healing and replacement of the osseous portion of cryopreserved allografts. Fractures that appeared to coincide with maximum revascularization of the graft were the principal complication. Articular surfaces of the cryopreserved allografts underwent degenerative changes over five years. These degenerative changes were also manifested radiologically and appeared similar to those observed in humans. By contrast, fresh osteoarticular allografts healed poorly through fibrous union. However, in one of two fresh allografts, the articular cartilage remained intact five years after transplantation.

Adolescent↗
PubMed1991

Scapular allografts. A report of two cases.

Some malignant tumors of the scapula can be adequately treated by limb-sparing, partial, or total scapulectomy. However, resection of the glenoid portion of the scapula and total scapulectomy result in an unsightly shoulder. In an attempt to minimize the functional impairment and restore stability and cosmesis, scapular glenoid allografts offer a reasonably good biologic replacement. This report describes the cases of a 45-year-old woman and a 32-year-old man in whom massive osteoarticular allografts were used. In one patient, good stability, cosmesis, and function were restored after resection of the glenoid portion. In the other patient, shoulder stability, cosmesis, and limited function were restored after total scapulectomy. No reports of scapular allografts seem to have been previously published in the literature.

Adult↗
PubMed1990

Massive allografts in salvage revisions of failed total knee arthroplasties.

Ten patients with failed total knee arthroplasties and severe bone loss were treated with massive whole distal femur and proximal tibial allografts in combination with prosthetic implants. Fourteen allografts were inserted either as invaginated or segmental grafts and were rigidly fixed to the host bone. Clinically and roentgenographically, 12 of 14 grafts (86%) seemed to have united to the host bone. The average range of motion was 92 degrees. Five patients developed complications; two of these involved the allograft (nonunion and fracture) and two were caused by inadequate healing at the ligament-allograft junction. One patient had a late infection. With careful planning and improved surgical techniques, these complications can be avoided. The massive allograft-prosthesis composite techniques is a viable reconstructive alternative worthy of further clinical trials.

Aged↗
PubMed1990

Pelvic allograft. A case report with a follow-up evaluation of 5.5 years.

A 23-year-old man with a large chondrosarcoma of the right bony pelvis was successfully treated by limb-saving internal hemipelvectomy and anatomic reconstruction of the pelvis by a pelvic osteoarticular allograft including the acetabulum. Optimum anatomic fit was achieved at the hip joint as well as at the iliac and pubic host-graft junctions, which were fixed with plates and screws. This reconstruction restored stability, leg length, hip motion, and cosmesis. Five and one-half years postoperatively, the patient remained asymptomatic with good functional and roentgenographic results.

Adult↗
PubMed1989

Malignant giant cell tumor of soft parts presenting as a skin tumor.

Malignant giant cell tumor of soft parts is a rare neoplasm that histologically resembles a giant cell tumor of bone. It has a distinctive multinodular growth pattern and is composed of numerous osteoclast-like giant cells, histiocytes, and fibroblasts. Although this tumor is usually found in deep soft tissues, a superficial form has been described in the subcutaneous tissue and fascia. The authors report two patients, aged 75 and 78, with malignant giant cell tumors presenting as ulcerating skin nodules of the arm and foot. The tumors were relatively small, measuring less than 3.5 cm in greatest dimension, and involved the entire dermis and subcutaneous tissue. The clinical differential diagnoses included Kaposi's sarcoma, melanoma, and hematoma. Dermatopathologists and dermatologists should be aware of this entity to avoid confusion with other benign and malignant neoplasms that may contain multinucleated giant cells. The distinguishing histologic and immunohistochemical features of this tumor are discussed.

Aged↗
PubMed1989

Massive allografts in surgery of bone tumors.

Large osseous and osteoarticular allografts have provided the orthopedic oncologist with a useful biological reconstructive alternative following wide en-bloc resection of bone tumors. Although the surgical procedures are complex, meticulous surgical techniques in terms of graft selection, allograft fixation, reconstruction of joint ligaments and tendons, and adequate skin coverage would produce satisfactory results in about three quarters of the patients. The potential causes of failure include allograft fracture, infection, nonunion and joint instability.

Adult↗
PubMed1988

Hemangiosarcoma of the left foot and tibia: case report.

A case of a hemangiosarcoma involving the bones of the foot in a diabetic patient who had swelling of the left foot is reported. Radiographs demonstrated multiple lytic areas throughout the bones of the foot. Clinically and radiographically, infection was suspected, but the biopsy revealed the presence of tumor. Metastases to the tibia were found and an above the knee amputation was performed. Chemotherapy was given, but 6 months later the patient died. Hemangiosarcoma is known to involve the different bones of the foot in a "multicentric" fashion and should be considered in the differential diagnosis of lytic lesions of multiple bones of the lower extremities.

Bone Neoplasms↗
PubMed1988

Computed tomography evaluation of stability in posterior fracture dislocation of the hip.

Measurements of the percentage of remaining posterior acetabulum on computed tomography (CT) scan (the Acetabular Fracture Index) in posterior fracture dislocations of the hip were evaluated to determine the stability of the joint. All hips with less than 34% of the remaining posterior acetabulum were unstable. Hips with greater than 55% were stable. Between these values, hips were either stable or unstable. A statistical analysis demonstrated highly significant differences in the average remaining posterior acetabulum between the stable and unstable group. These findings were based on a review of 26 patients with posterior fracture dislocations of the hip (Epstein Type I-IV injuries) combined with CT scan analysis. The clinical status of hip stability was correlated with the Acetabular Fracture Index, and this provided the basis for the study. A simple linear measurement of the remaining posterior acetabulum on CT (the Approximate Acetabular Fracture Index) can be done easily by a physician, and this closely approximates the true remaining acetabular arc. Seven of ten unstable hips in 31 Epstein Type I-V patients showed femoral head subluxation of 0.5 mm or more on CT scan, whereas none of the 21 stable hips had demonstrable subluxation. Risk analysis provided a means of predicting hip stability for individual patients.

Acetabulum↗
PubMed1986

Solitary osseous myeloma with polyneuropathy. Case report and review of the literature.

Solitary osseous myeloma is an uncommon malignancy of bone which is distinguished from multiple myeloma by being localized and without associated monoclonal gammopathy or Bence-Jones proteinuria. This disease may present with a progressive symmetrical sensorimotor neuropathy. A recent case of localized myeloma with polyneuropathy is presented along with a review of the literature pertinent to orthopedic surgeons.

Acetabulum↗
PubMed1985

Subacute and chronic bone infections: diagnosis using In-111, Ga-67 and Tc-99m MDP bone scintigraphy, and radiography.

The usefulness of indium-111 white blood cell scintigraphy in the diagnosis of subacute or chronic bone infection was examined in 21 orthopedic patients. In-111 WBC imaging was compared with gallium-67 and technetium-99m methylene diphosphonate skeletal scintigraphy and bone radiography, all studies being performed within 1 week. In-111 WBC scintigraphy showed no definite advantage over Ga-67 scintigraphy in the identification of chronic bone infection. The two tests had the same sensitivity (80%) and similar specificity (In-111 WBC 75%, Ga-67 83%; difference not significant). Bone radiography had a sensitivity of 60% and a specificity of 67%. A negative Tc-99m MDP bone scintigram ruled out infection (sensitivity 100%), but because of low specificity (25%), final evaluation required performance of Ga-67 or In-111 WBC scintigraphy.

Adult↗
PubMed1982

The total thigh and rectus abdominis myocutaneous flap for closure of extensive hemipelvectomy defects.

Hemipelvectomy is a lifesaving procedure when used appropriately and yields a 35%, five-year survival in the cancer patient. However, the standard posterior flap for closure is not always available. Two flaps, the thigh flap and the rectus abdominis myocutaneous flap, are described in which any soft tissue defect resulting from hemipelvectomy can be safely closed primarily when the posterior flap is not available. The total rectus abdominis flap is previously undescribed and unique in its application. These techniques significantly contribute to the surgeon's armamentarium for decreasing morbidity and mortality and resectability of unusual pelvic and thigh tumors.

Abdominal Muscles↗