Showing papers by "Robert S. Bell published in 1994"

Prognostic factors in osteosarcoma : a critical review

Abstract: PURPOSEThe purpose of this critical appraisal was to determine the prognostic factors that influence survival in patients with nonmetastatic, high-grade osteosarcoma of the extremities.DESIGNA computerized literature search of reports published from January 1973 to March 1992 was conducted to determine those eligible for inclusion in the review. Reports were reviewed blindly by two of the authors; inclusion and scoring were determined according to preestablished criteria.RESULTSEight reports were included in the appraisal. The prognostic variables evaluated were age, sex, anatomic tumor location, tumor size, and tumor necrosis. Tumor size and necrosis following preoperative chemotherapy were significant prognostic variables in relation to survival in univariate analysis. However, only tumor necrosis maintained its significance in multivariate modeling.CONCLUSIONThe most important prognostic variable for patients with osteosarcoma of the extremity was tumor necrosis evident following preoperative chemother...

Wound-healing complications after soft-tissue sarcoma surgery

Abstract: One-hundred and eighty patients undergoing limb-salvage surgery for soft-tissue sarcoma from 1986 to 1991 were assessed retrospectively for risk factors associated with major wound-healing complications. Twenty-three of 137 patients (16 percent) treated with primary direct wound closure sustained complications. In univariate analysis, the cross-sectional area of tumor resection, the use of preoperative irradiation, the width of the skin excision, a history of smoking, and a history of diabetes and/or vascular disease were associated with wound failure. Multivariate analysis revealed that preoperative irradiation (p = 0.04) and resection diameter (p = 0.017) accounted for the risk of complications. Eighteen additional patients were treated empirically with distant vascularized tissue transfer following preoperative irradiation because of concerns regarding potential wound complications. The lower complication rate in this group suggested that vascularized tissue transfer may be beneficial in lowering wound complication rates.

Histological necrosis in soft tissue sarcoma following preoperative irradiation

Abstract: Forty-eight patients with soft tissue sarcomas that presented adverse features for treatment by limb salvage surgery and postoperative irradiation were treated by preoperative irradiation and surgery using a consistent protocol. Following resection, the extent of histological necrosis in the specimen was scored according to the criteria of Willet et al. Of the 48 cases, 16 (34%) demonstrated Grade 1 response ( 80% necrosis). There was a trend toward more extensive necrosis in liposarcoma tumors (53% showing Grade 3 response compared to 26% of other sarcomas). Logistic regression analysis demonstrated a significant relationship between necrosis and tumor size (P < 0.001) with larger tumors having higher grades of necrosis. Tumor grade did not seem to affect the extent of necrosis. In comparison to the previous report of necrosis in soft tissue sarcoma following irradiation, the current analysis revealed a smaller proportion of tumors with Grade 3 necrosis.

Foreign-body abscesses presenting as soft-tissue tumours: two case reports.

Abstract: Foreign bodies in the extremities often present as bony extensions of soft-tissue masses. Wooden foreign bodies can be detected by computed tomography and magnetic resonance imaging, but these studies are often nonspecific and cannot detect small bodies. As illustrated by two cases reported in this paper, these masses are difficult to distinguish from primary soft-tissue sarcomas when the history and imaging findings suggestive of a foreign-body reaction are absent.

Diagnosis and management of sacral bone tumours.

Abstract: OBJECTIVE: To evaluate the efficacy of current treatment in patients with sacral bone tumours. DESIGN: Retrospective case series. SETTING: A quaternary care unit within a teaching hospital. PATIENTS: Twenty-nine patients with sacral tumours referred to the unit between 1983 and 1991. Follow-up was a minimum of 18 months. INTERVENTIONS: Diagnostic biopsy in all patients. Plain radiography, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) and bone scanning. Sacral resection in patients with malignant or aggressive primary bone tumours. MAIN OUTCOME MEASURES: The accuracy of biopsy and local and systemic recurrence of the disease. RESULTS: Symptoms were present for a mean of 12 months to the time of presentation. Low-back pain was present in 28 of 29 patients. Radicular pain and sacral nerve dysfunction were found more often in patients with malignant tumours. Only three patients had altered bowel habits. On rectal examination a mass was palpable in 61% of patients. The sacral abnormality was demonstrated by plain radiography in 6 of 9 cases, by ultrasonography in 2 of 7 cases, by bone scanning in all of 17 cases, by CT in 24 of 25 cases and by MRI in 17 of 18 cases. Fine-needle aspiration biopsy provided the correct diagnosis in only one of four patients. Transrectal biopsy resulted in tethering of the rectum to the tumour in two patients. Core needle biopsy gave an accurate diagnosis in eight of nine patients. Open biopsy was repeated to obtain adequate tissue in 3 of 19 patients.(ABSTRACT TRUNCATED AT 250 WORDS)