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Biomedical subjects

William G Ward

Publications and source records attributed to William G Ward.

15 recordsLinked to original sources
PubMed2007

Diffuse pigmented villonodular synovitis: preliminary results with intralesional resection and p32 synoviorthesis.

Because of the high local recurrence rate associated with surgical resection alone, patients with diffuse intraarticular pigmented villonodular synovitis were treated with surgical resection followed by colloidal chromic P32 synoviorthesis. The medical records of nine consecutive patients treated in this manner were reviewed retrospectively to determine the recurrence rate of pigmented villonodular synovitis. All patients had either one or two surgical resections (arthroscopy in one patient, open resection in seven, arthroscopy and open resection in one). The involved joints included six knees and one each, ankle, elbow, and hip. Eight of the nine patients remained recurrence free at a mean followup of 38 months (range, 19-60 months) after surgery. One patient had a suspected asymptomatic recurrence documented by magnetic resonance imaging 29 months after surgery. Seven patients reported their normal activities as unrestricted. Five reported improved activity levels, one reported the activity level remained the same, and one reported activity as the same or better. None reported reduced activity levels. In these patients synoviorthesis with colloidal chromic P32 following gross resection of all obvious pigmented villonodular synovitis provided local disease control in all but one.

Adolescent↗
PubMed2006

Diagnostic pitfalls associated with fine-needle aspiration biopsy in a patient with the myxoid variant of monophasic fibrous synovial sarcoma.

Synovial sarcoma (SS) is one of the most common soft tissue tumors that typically presents in the extremities of young adults, but may occur at any site and affect children during the first decade. Herein we discuss a 12-yr-old male who complained of left foot pain and plantar mass. A fine-needle aspiration biopsy of an 8 cm subcutaneous mass was performed revealing a myxoid spindle cell neoplasm. The cytologic differential diagnosis included a myxoid neurofibroma, neurothekeoma, and a myxoid sarcoma. Subsequent excision of the mass revealed a monophasic fibrous SS with myxoid features. Examination of the tissue by fluorescence in situ hybridization confirmed the presence of characteristic SS SYT gene rearrangement at chromosome 18q11.2. This case underscores that the cytologic distinction of mxyoid spindle cell tumors may be challenging. We report the cytologic features of a myxoid monophasic fibrous SS, and discuss its distinction from other benign and malignant myxoid soft tissue neoplasms.

Biopsy, Fine-Needle↗
PubMed2005

Human leukocyte antigen sensitization after structural cortical allograft implantations.

UNLABELLED: The incidence and significance of a donor-specific human leukocyte antigen antibody response to massive fresh-frozen human bone allograft implantation is not established. This study was a prospective, multicenter study of a cohort of consecutive patients who self-randomized themselves into two groups based on their alloantibody response to allograft bone transplant. The study hypothesis was that donor-directed antibodies are an independent risk factor influencing incorporation of massive frozen bone allografts. Pretransplant and posttransplant human leukocyte antigen alloantibody analysis was performed and correlated to determine pre-existing and graft-induced antibodies. The surgical outcomes of the two groups of patients were compared to determine the relationship between alloantibody response and bone graft incorporation. Preliminary results revealed that donor-specific human leukocyte antigen sensitization occurred in 17 of 32 (53%) of previously nonsensitized patients. A survival analysis of time to healing based on human leukocyte antigen status showed no evidence of an association between human leukocyte antigen status and time to healing. Longer followup in additional patients will be required to determine if this sensitization is correlated with an alteration in the time to union or with the quality or type of bone graft incorporation. LEVEL OF EVIDENCE: Therapeutic study, Level II. See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2004

Soft-tissue lumps and bumps.

Soft-tissue masses of the extremities and torso are a common problem encountered by the orthopaedic surgeon. Although these soft-tissue masses are often benign, the orthopaedic surgeon must be able to recognize the features key to differentiating benign and malignant masses. An understanding of the epidemiology and clinical presentation of soft-tissue masses is needed in order to outline a practical approach to evaluation and surgical management.

Biopsy↗
PubMed2003

Endoprosthetic reconstructions for bone metastases.

The purpose of the current study was to help define the role that endoprosthetic reconstructions have in the treatment of metastatic bone disease. Of the 522 endoprostheses implanted at the University of California at Los Angeles (UCLA) between December 1980 and January 2002, 37 (6.9%) were used in 37 patients with metastatic disease. Upper extremity locations outnumbered lower extremity locations 2:1. The 20 males and 17 females ranged in age from 10 to 82 years, with a median age of 54 years. Metastatic renal and breast carcinoma predominated and accounted for 60% of the lesions. The lesion was a primary metastasis in 27 patients (73%) and a revision of failed previous surgery in 10 patients (27%). Only five patients experienced local complications none of whom required reoperation or amputation. Thirty-three of the 37 patients died of disease progression at a median of 12 months (range, 4-49 months). Function after endoprosthetic reconstruction for metastatic disease is similar to that of function for endoprosthetic reconstructions used for primary malignant tumors, but clearly is dependent on the patient's general condition. Although infrequently used to treat bone metastases, endoprosthetic reconstruction can be a useful alternative reconstruction in selected situations.

Adolescent↗
PubMed2003

Treatment of metastatic disease of the tibia.

Metastatic lesions to bone outnumber primary bone malignancies. Osseous metastases to the tibia tend to be less common than osseous metastases to other long bones. This study examined the treatment options for a population of patients with metastatic disease to the tibia, with surgical intervention being the cornerstone of treatment for the osseous lesion. A multicenter study had 592 patients with metastatic disease to the bone, with 26 lesions occurring in the tibia (4.4%) during a 13-year period. No patient had concurrent metastases distal to the elbow. After confirmation of metastatic disease, treatment consisted of surgical intervention in all patients, including plate osteosynthesis, intramedullary rodding and cementation, endoprosthetic replacement, and in most patients, postoperative radiation therapy. In 96% of patients, the reconstruction outlasted their life expectancy. All patients were satisfied with their reconstruction. Four complications were encountered in the postoperative period, all requiring additional surgery. Aggressive treatment of osseous metastasis is justified in patients with metastatic disease despite a limited life expectancy. Intervention by an orthopaedic oncologist may result in fewer reconstructive failures. Surgical intervention contributes to an improved quality of life and limb function, ease of nursing care, and may help in maintaining patient independence.

Adult↗
PubMed2003

Metastatic disease of the femur: surgical treatment.

The senior author's 12-year consecutive series of surgery for metastatic disease of the femur was reviewed. Treatment of 97 impending pathologic fractures yielded better results than treatment of 85 completed pathologic fractures with less average blood loss (438 cc versus 636 cc), shorter hospital stay (7 days versus 11 days), greater likelihood of discharge to home as opposed to an extended care facility (79% versus 56%) and greater likelihood of resuming support-free ambulation (35% versus 12%). Internal stabilization with a reconstruction-type intramedullary nail provided satisfactory pain relief and functional preservation for most patients with impending pathologic femur fractures (69 of 97, 71%), although alternate forms of internal fixation (21 of 97, 22%) or cemented arthroplasty (seven of 97, 7%) were used successfully. Completed pathologic fractures were more likely to require some form of arthroplasty (47 of 85, 55%), although reconstruction-type nails (20 of 85, 24%), and other internal fixation techniques (18 of 85, 21%) also were used. Modular oncology-type arthroplasty systems offered a viable salvage option in both groups. In the absence of conflicting goals or contraindications, internal stabilization of impending pathologic fractures before the completion of the fracture seems to be reasonable and appropriate.

Arthroplasty, Replacement↗
PubMed2003

Custom cross-pin fixation of 32 tumor endoprostheses stems.

The main cause of mechanical failure of primary and revision cemented tumor endoprosthetic stems is aseptic loosening. The placement of custom designed pins through the bone, the cement, and the stem can create a bone-cement-prosthesis composite that resists the rotatory stresses that lead to aseptic loosening. At risk situations include large primary reconstructions where the residual short metaphyseal articular segments lack sufficient length and cortical contact to provide lasting fixation, and revision prostheses that are to be recemented into straight diaphyseal segments that already have experienced aseptic loosening. Current modular tumor endoprosthetic systems have improved availability and allow for some intraoperative flexibility, but they do not provide solutions for these at risk scenarios. Additional customization is necessary. We report on the 16-year experience with 32 custom cross-pin stems at the University of California, Los Angeles (UCLA). Twenty of these patients have been followed up for more than 2 years. There were three mechanical failures, three patients were lost to followup, and five patients died of disease. There have been no cases of aseptic loosening in this series. Cross-pin fixation has been effective when used in carefully selected cases.

Adolescent↗
PubMed2003

Dislocation of rotating hinge total knee prostheses. A biomechanical analysis.

BACKGROUND: Symptomatic instability and implant dislocation are occasionally encountered in patients with a rotating hinge total knee prosthesis. A biomechanical study of rotating hinge total knee implants was performed to determine the association between the design (length and taper) of the central rotational stem and the stability of the implant. METHODS: The stem lengths and tapers of knee implants made by seven manufacturers were measured. The tilting laxity of each design was tested by measuring the degree of tilting of the central rotational stem within the tibial housing that occurred with increasing amounts of distraction. The maximum amount of distraction that was possible before the stem dislocated was determined for each design. RESULTS: Implant designs with a short and/or markedly tapered central rotational stem had the greatest tilting, laxity, and instability of that stem. The Howmedica, Techmedica, Intermedics/Sulzer Medica, and Wright Medical Technology/ Dow Corning Wright designs required > or = 39 mm of distraction before they dislocated. The Biomet knee implant required 33 or 44 mm of distraction to dislocate, depending on the thickness of the polyethylene tray that was utilized. The S-ROM knee required only 26 mm of distraction before dislocation occurred. CONCLUSIONS: The measurements confirmed that the shorter the stem and the greater its taper, the greater the instability and laxity at any given amount of joint distraction.

Biomechanical Phenomena↗
PubMed2002

Customized treatment algorithm for giant cell tumor of bone: report of a series.

Between 1991 and 2000, 30 patients with 31 resections of giant cell tumors of bone were treated (average followup, 4.9 years; range, 1-9.6 years). Intralesional resection with curettes and a high-speed burr and reconstruction with polymethylmethacrylate cementation or bone grafting was used for salvageable, nonexpendable bones. Wide resection and allograft reconstruction was done in nonexpendable bones that were too destroyed for salvage. Adjuvant treatments were used for all intralesional procedures and when wide resection with a close margin was obtained. Adjuvant treatments included hydrogen peroxide instillation in 30 patients, electrocautery in 27 patients, phenol irrigation in 26 patients, sterile water irrigation in 15 patients, and polymethylmethacrylate cementation in 15 patients. There have been only two (6.4%) local recurrences, one in bone and one in soft tissue. Both patients had intralesional resections initially and both had salvage procedures with wide resections of the recurrent tumors. The 5-year recurrence-free survivorship was 93%. A delayed ray amputation for failed bone graft of the little finger was the only amputation. In all other patients, a functional limb was preserved. Wide resection only is required when bone salvageability is impractical. Intralesional curettage and high-speed burr resection, when supplemented with the adjuvant therapies as described, is adequate for the majority of patients with giant cell tumor of bone. A proposed treatment algorithm is presented.

Adult↗
PubMed2002

Animal model for evaluation of soft tissue ingrowth into various types of porous coating.

Results from several studies have suggested that soft tissue ingrowth into porous coating can serve as a biologic containment mechanism to prevent particulate debris migration by sealing off the effective joint space. Therefore, a rabbit animal model was developed to investigate soft tissue ingrowth into various types of metallic rods. After implantation of several types of coated and smooth rods within the thigh musculature of rabbits, a thick encapsulation of soft tissue was observed around porous-coated rods whereas a nonadherent pseudosynovial-lined cavity was observed around smooth rods. Within 3 weeks, soft tissue had grown into the three different types of porous coating on the rods. Histologic evaluation verified that maturation of this ingrowth tissue occurred by 12 weeks. Incomplete soft tissue ingrowth occurred into the depths of large-bead (590-840 mm) porous-coated surfaces. Soft tissue separation from the bead surfaces was observed at 12 weeks in the porous-coated implants that also had been coated with a thin layer of tricalcium phosphate. These findings suggest that soft tissue ingrowth can be expected to occur into the porous coatings tested, but that tricalcium phosphate should not be used as an additional surface coating to obtain long-term adherence of circumferential soft tissue ingrowth.

Animals↗
PubMedDate not supplied

Potential sampling error in fine needle aspiration biopsy of dedifferentiated chondrosarcoma: a report of 4 cases.

BACKGROUND: Dedifferentiated chondrosarcoma is a rare, poorly understood and often fatal sarcoma that usually manifests as a high grade, non-cartilage-producing sarcoma juxtaposed against a low grade chondrosarcoma. A correct diagnosis requires recognition of both components. In the absence of complete resection, rendering a specific diagnosis on small biopsy specimens, such as fine needle aspiration biopsy (FNAB), may be extraordinarily difficult. CASES: We retrospectively reviewed 4 cytology samples (3 primary, 1 metastatic) from 3 patients with dedifferentiated chondrosarcoma, initially analyzed by FNAB, emphasizing the potential for sampling error. Two women, aged 78 and 57 years, both of whom had prior histories of carcinoma, presented with lesions involving the right and left femur, respectively. One 27-year-old man with multiple osteochondromatosis developed a dedifferentiated chondrosarcoma of the left pelvis. Two primary cytologic specimens consisted of moderately cellular smears containing a spindled to polygonal, nonspecific, pleomorphic sarcoma unaccompanied by definite matrix material; 1 of these had a concomitant core needle biopsy (CNB), also demonstrating pleomorphic sarcoma. The third primary cytologic specimen revealed low grade chondrosarcoma, but a concomitant CNB showed only a high grade, non-matrix-producing sarcoma. The last patient developed a metastasis to the opposite femur; FNAB revealed a high grade spindle cell sarcoma. In none of the FNAB or CNB specimens were both low and high grade components of dedifferentiated chondrosarcoma recognized. However, the diagnosis was strongly suspected based on the clinical and radiographic findings. CONCLUSION: Due to sampling error, the diagnosis of dedifferentiated chondrosarcoma may be difficult to establish by cytologic examination alone. Clinical and radiographic correlation is essential for an accurate diagnosis.

Adult↗