23 results on '"Esther RJ"'
Search Results
2. Development and use of a second-year musculoskeletal organ-system curriculum: a forty-year experience.
- Author
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Wilson FC, Esther RJ, Wilson, Frank C, and Esther, Robert J
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- 2010
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3. A call for an end to 'past medical history'.
- Author
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Esther RJ
- Published
- 2005
4. Clarity of language.
- Author
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Laird T, Sanders S, Esther RJ, and Laird, Tim
- Published
- 2006
5. Recurrent Hemarthrosis following Resections of Benign Bone Tumors: A Case Report of Two Pediatric Cases.
- Author
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Barnes RH, Harter D, Esther RJ, Kamath GV, and Vergun AD
- Abstract
Introduction/Cases . Two pediatric patients presenting with benign bone tumors of the distal femur at the level of the suprapatellar fat pad developed late onset recurrent knee hemarthrosis following surgical treatment of the lesions. A sinus tract from the intramedullary bone to the knee capsule was discovered in both patients during surgical exploration. Resection of the sinus tract and full closure of the knee capsule resulted in no further recurrence. Conclusion. Postoperative knee effusions in patients following resection near the distal femur could represent hemarthrosis that require additional workup and treatment. Resection of the sinus tract successfully treats the hemarthrosis., Competing Interests: No authors have conflicts of interest to declare., (Copyright © 2021 Ryan H. Barnes et al.)
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- 2021
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6. Pathologic nodal staging for clinically node negative soft tissue sarcoma of the extremities.
- Author
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Maduekwe UN, Herb JN, Esther RJ, Kim HJ, and Spanheimer PM
- Subjects
- Adolescent, Adult, Aged, Databases, Factual, Humans, Middle Aged, Neoplasm Staging, Retrospective Studies, Sarcoma mortality, Sarcoma therapy, Soft Tissue Neoplasms mortality, Soft Tissue Neoplasms therapy, Survival Rate, Young Adult, Extremities, Sarcoma pathology, Soft Tissue Neoplasms pathology
- Abstract
Background and Objectives: Synovial, clear cell, angiosarcoma, rhabdomyosarcoma, and epithelioid (SCARE) soft tissue sarcoma are at risk for nodal involvement, although the nodal positivity rates and impact on prognostication in clinically node negative patients are not well described., Methods: Patients with extremity SCARE sarcoma without clinical nodal involvement undergoing surgical resection in the National Cancer Database (2004-2017) were included. Logistic regression was used to evaluate the likelihood of nodal surgery and nodal positivity. Kaplan-Meier method and Cox regression were used to assess associations of nodal status to overall survival., Results: We included 4158 patients, and 669 patients (16%) underwent regional lymph node surgery (RLNS). On multivariable logistic analysis, patients with epithelioid (odds ratio [OR]: 3.77; p < .001) and clear cell (OR: 6.38; p < .001) were most likely to undergo RLNS. Forty-five patients (7%) had positive nodes. Clear cell sarcoma (14%) and angiosarcoma (13%) had the highest rates of nodal positivity. Patients with positive nodes had reduced 5-year overall survival, and the stratification was largest in clear cell and angiosarcoma., Conclusion: Discordance exists between selection for pathologic nodal evaluation and factors associated with nodal positivity. Clinically node negative patients with clear cell and angiosarcoma should be considered for pathologic nodal evaluation., (© 2021 Wiley Periodicals LLC.)
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- 2021
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7. Does Timing Matter? Surgical Outcomes in High-Grade Sarcomas after Neoadjuvant Radiation Therapy.
- Author
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Louie RJ, Wang K, Royce TJ, Beaty BT, Esther RJ, Tepper JE, and Kim HJ
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- Aged, Cohort Studies, Disease-Free Survival, Female, Humans, Male, Neoplasm Recurrence, Local epidemiology, Postoperative Complications epidemiology, Retroperitoneal Neoplasms radiotherapy, Retroperitoneal Neoplasms surgery, Retrospective Studies, Time Factors, Treatment Outcome, Neoadjuvant Therapy methods, Sarcoma radiotherapy, Sarcoma surgery
- Abstract
Background: The impact of time to surgical resection after neoadjuvant external beam radiation therapy (EBRT) in the high-grade soft tissue and retroperitoneal sarcomas has not been well established. We aimed to evaluate how surgical timing from EBRT affects oncologic and perioperative outcomes., Methods: We performed a single institution retrospective cohort study of patients with biopsy-proven, high-grade sarcoma who completed neoadjuvant EBRT and resection from January 1, 1999 to September 1, 2018. We collected demographic and clinicopathologic variables, stratifying patients by time interval between EBRT and surgery: <6, 6-8, 8-10, and >10 wk. Primary outcomes collected were as follows: disease-free survival, overall survival, and perioperative complications., Results: Of the 269 patients identified, 146 met inclusion criteria. The median follow-up was 24 mo. Overall and local recurrence were 37% (n = 54) and 14.4% (n = 21), respectively. Time to surgery did not affect recurrence (P = 0.82) or survival (P = 0.88). Positive margins (odds ratio 2.7, confidence interval 1.14, 6.51, P < 0.05) were predictive of recurrence. Primary tumor location, surgical timing, histology, and intraoperative radiation therapy were not associated with differences in recurrence. The overall complication rate was 28%, with 63% from wound infections. Fewer postoperative complications occurred in the < 6-wk cohort versus > 6-wk cohort (15% versus 38%, P < 0.05)., Conclusions: We found no difference in oncologic outcomes associated with the timing of surgical resection after EBRT. Patients undergoing resection >6 wk were at higher risk for all complications without impacting wound complication rates. Future studies may include preoperative optimization of patients requiring delays in surgical planning to decrease perioperative complication rates., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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8. Iatrogenic lesions of soft tissue and bone.
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O'Connor SM, Wobker SE, Cardona DM, Eward W, Esther RJ, and Dodd LG
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- Bone Neoplasms pathology, Bone Neoplasms therapy, Breast Neoplasms pathology, Breast Neoplasms therapy, Cell Proliferation, Drug-Related Side Effects and Adverse Reactions, Equipment and Supplies adverse effects, Female, Hemangiosarcoma pathology, Hemangiosarcoma therapy, Humans, Iatrogenic Disease, Radiotherapy adverse effects, Soft Tissue Neoplasms pathology, Soft Tissue Neoplasms therapy, Bone Neoplasms diagnostic imaging, Breast Neoplasms diagnostic imaging, Hemangiosarcoma diagnostic imaging, Soft Tissue Neoplasms diagnostic imaging
- Published
- 2018
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9. Not All Patients Undergoing Stabilization of Impending Pathologic Fractures for Renal Cell Carcinoma Metastases to the Femur Need Preoperative Embolization.
- Author
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Jernigan EW, Tennant JN, and Esther RJ
- Subjects
- Aged, Blood Loss, Surgical prevention & control, Blood Transfusion, Carcinoma, Renal Cell secondary, Carcinoma, Renal Cell surgery, Databases, Factual, Embolization, Therapeutic adverse effects, Female, Femoral Fractures etiology, Femoral Fractures pathology, Femoral Neoplasms secondary, Femoral Neoplasms surgery, Fracture Fixation adverse effects, Fractures, Spontaneous etiology, Fractures, Spontaneous pathology, Humans, Male, Postoperative Hemorrhage prevention & control, Preoperative Care adverse effects, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Carcinoma, Renal Cell therapy, Embolization, Therapeutic methods, Femoral Fractures prevention & control, Femoral Neoplasms therapy, Fracture Fixation methods, Fractures, Spontaneous prevention & control, Kidney Neoplasms pathology, Preoperative Care methods
- Abstract
Background: Preoperative transarterial embolization has been utilized in the surgical treatment of metastatic renal cell carcinoma of the femur to decrease perioperative blood loss. However, few studies have documented its efficacy in decreasing the proportion of patients receiving transfusions in the setting of prophylactic treatment of impending pathologic femur fractures., Questions/purposes: In a population of patients with metastatic renal cell carcinoma of the femur who underwent prophylactic fixation, the purpose of this study was to quantify and compare the proportion of patients who received at least one transfused unit of blood between a group treated with preoperative embolization and a group without preoperative embolization., Methods: A retrospective study was performed using a Medicare claims-based database. International Classification of Diseases, 9 Revision and Current Procedural Terminology codes were used to identify 1285 patients with metastatic renal cell carcinoma of the femur who underwent prophylactic fixation. The proportion of patients who received one or more blood transfusions was compared between 135 patients who underwent preoperative embolization and a group of 1150 concurrent control patients who did not undergo preoperative embolization. The control group was older than the embolization group, with 44% of these patients > 75 years old and 33% of the embolization group > 75 years. There was no difference in the female:male ratio between groups. Statistical comparisons of outcomes related to transfusion percentages were performed using Pearson chi square analysis with p < 0.05 considered significant. With the numbers available, we had 80% power to detect a difference in the percentage of patients transfused of 11% between the study groups at α = 0.05., Results: No difference in transfusion percentage was observed between preoperative transarterial embolization (41 of 135 [30%]) and the control group (359 of 1150 [31%]; relative risk, 0.973; 95% confidence interval, 0.743-1.274; p = 0.84). The percentage of all patients who received a transfusion was 31% (400 of 1285)., Conclusions: Preoperative embolization may not be mandatory in the prophylactic treatment of metastatic renal cell carcinoma of the femur, as demonstrated by the 69% of patients who received zero units of blood despite not receiving embolization. However, assessment of the efficacy of embolization in decreasing blood loss in the current study is limited as a result of biases associated with the database design of the study; the decision of whether to send a patient for embolization should be made on a case-by-case basis. The current study does not identify specific risk factors that should factor into this decision and underscores the need for further research in this regard. A plausible future research design to account for the low numbers and selection bias that limited the current study as well as the existing studies might be a multicenter, retrospective case-control study., Level of Evidence: Level III, therapeutic study.
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- 2018
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10. Intraosseous Rosai-Dorfman disease diagnosed by touch imprint cytology evaluation: A case series.
- Author
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Pendse AA, Wobker SE, Greene KG, Smith SV, Esther RJ, and Dodd LG
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- Adolescent, Adult, Diagnosis, Differential, Female, Humans, Lymph Nodes pathology, Male, Histiocytosis, Sinus pathology
- Abstract
Sinus histiocytosis with massive lymphadenopathy, also known as Rosai-Dorfman disease (RDD) is a rare benign disorder that primarily affects the lymph nodes. Localized lymphadenopathy is the most common clinical manifestation of this disorder. However, RDD has been described in several extra-nodal sites including the head and neck region, soft tissue, skin, upper respiratory tract, gastro-intestinal tract and central nervous system (CNS). Involvement of the bone is considered very rare, occurring in less than 10% patients. RDD is one of the histiocytoses and the differential diagnosis includes entities such as Langerhans cell histiocytosis and Erdheim-Chester disease. In the rare intraosseous variant, the clinical and radiologic differential diagnosis is broader and includes neoplasms such as osteosarcoma and Ewing sarcoma. In this report, we describe three cases of extra-nodal, intraosseous RDD where touch imprint cytology played a crucial role in diagnosis. Two of the cases initially presented with involvement of the head and neck region and later developed intraosseous disease; while the third patient presented with primary bone involvement. The diagnosis was established by core biopsy with touch imprints of the bone lesions. The cytologic samples showed numerous histiocytes, often with neutrophils within their cytoplasm (emperipolesis) in addition to lymphocytes and plasma cells. The diagnosis of RDD was confirmed with appropriate immunohistochemical stains. Our account of these three cases of intraosseous Rosai-Dorfman disease highlights the role of cytology in the diagnosis of this rare entity., (© 2017 Wiley Periodicals, Inc.)
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- 2018
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11. Fringe Benefits Among US Orthopedic Residency Programs Vary Considerably: a National Survey.
- Author
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Clement RC, Olsson E, Katti P, and Esther RJ
- Abstract
Background: Residency programs compete to attract applicants based on numerous factors. Previous research has suggested that medical students consider quality of life among the most important factors in selecting a program. One aspect of workplace quality of life is the cadre of non-monetary benefits offered to employees. However, with federal funding for graduate medical education (GME) under consideration for spending cuts, the source and continuation of such benefits may be in question., Questions/purposes: This study aimed to determine the level and variability of benefits beyond standard salary and insurance options available to trainees at US orthopedic residency programs and to assess the source of funding for those benefits., Methods: A 26-question survey investigating various benefits and funding sources was circulated by email to all ACGME-accredited orthopedic residency programs., Results: The survey was sent to 153 programs and 69 responded (45%). The majority offers their residents discretionary funds (77%) and conference funding (96%), most of which comes from the department, followed by the hospital or GME funding. Forty-one percent of respondents permit their residents to moonlight. The majority of respondents provide meal stipends (93%), free parking (71%), gym benefits (63%), surgical loupes (53%), and maternity/paternity leave beyond vacation time (55%). No statistically significant differences were found among top ranked residencies, top ranked orthopedic hospitals, or academic centers compared to their counterparts., Conclusion: While some benefits are commonly offered, there is great variation in the availability and level of others. However, these differences were independent of program and hospital reputation as well as academic center status. Departments currently bear a substantial amount of the cost of these benefits internally.
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- 2016
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12. Soft tissue masses for the general orthopedic surgeon.
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Jernigan EW and Esther RJ
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- Adolescent, Adult, Aged, Diagnosis, Differential, Disease-Free Survival, Female, Humans, Lipoma pathology, Lipoma surgery, Magnetic Resonance Imaging methods, Male, Middle Aged, Myositis Ossificans pathology, Myositis Ossificans surgery, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local surgery, Neurofibroma diagnosis, Neurofibroma diagnostic imaging, Risk Assessment, Sarcoma mortality, Sarcoma surgery, Soft Tissue Neoplasms mortality, Soft Tissue Neoplasms surgery, Survival Analysis, Tomography, X-Ray Computed methods, Diagnostic Imaging methods, Neoplasm Recurrence, Local pathology, Orthopedics methods, Sarcoma pathology, Soft Tissue Neoplasms pathology
- Abstract
Soft tissue sarcomas are a rare, heterogeneous group of malignancies that should be included in the differential diagnosis for any patient presenting with a soft tissue mass. This article reviews strategies for differentiating between benign and malignant soft tissue masses. Epidemiology, appropriate workup, and treatment of soft tissue sarcomas are reviewed., (Copyright © 2015 Elsevier Inc. All rights reserved.)
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- 2015
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13. Wound complications in preoperatively irradiated soft-tissue sarcomas of the extremities.
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Rosenberg LA, Esther RJ, Erfanian K, Green R, Kim HJ, Sweeting R, and Tepper JE
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- Adult, Aged, Aged, 80 and over, Female, Hematoma etiology, Hematoma surgery, Humans, Male, Middle Aged, Postoperative Complications mortality, Postoperative Complications surgery, Preoperative Care adverse effects, Preoperative Care methods, Reoperation statistics & numerical data, Retrospective Studies, Sarcoma mortality, Sarcoma pathology, Seroma etiology, Seroma surgery, Suction, Surgical Flaps blood supply, Tumor Burden, Young Adult, Extremities, Postoperative Complications etiology, Sarcoma radiotherapy, Sarcoma surgery
- Abstract
Purpose: To determine whether the involvement of plastic surgery and the use of vascularized tissue flaps reduces the frequency of major wound complications after radiation therapy for soft-tissue sarcomas (STS) of the extremities., Methods and Materials: This retrospective study evaluated patients with STS of the extremities who underwent radiation therapy before surgery. Major complications were defined as secondary operations with anesthesia, seroma/hematoma aspirations, readmission for wound complications, or persistent deep packing., Results: Between 1996 and 2010, 73 patients with extremity STS were preoperatively irradiated. Major wound complications occurred in 32% and secondary operations in 16% of patients. Plastic surgery closed 63% of the wounds, and vascularized tissue flaps were used in 22% of closures. When plastic surgery performed closure the frequency of secondary operations trended lower (11% vs 26%; P=.093), but the frequency of major wound complications was not different (28% vs 38%; P=.43). The use of a vascularized tissue flap seemed to have no effect on the frequency of complications. The occurrence of a major wound complication did not affect disease recurrence or survival. For all patients, 3-year local control was 94%, and overall survival was 72%., Conclusions: The rates of wound complications and secondary operations in this study were very similar to previously published results. We were not able to demonstrate a significant relationship between the involvement of plastic surgery and the rate of wound complications, although there was a trend toward reduced secondary operations when plastic surgery was involved in the initial operation. Wound complications were manageable and did not compromise outcomes., (Copyright © 2013 Elsevier Inc. All rights reserved.)
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- 2013
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14. Osteolipoma: radiological, pathological, and cytogenetic analysis of three cases.
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Fritchie KJ, Renner JB, Rao KW, and Esther RJ
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- Adult, Female, Genetic Predisposition to Disease genetics, Humans, Male, Middle Aged, Bone Neoplasms diagnosis, Lipoma diagnosis, Lipoma genetics, Magnetic Resonance Imaging methods, Tomography, X-Ray Computed methods
- Abstract
Osteolipoma is a rare variant of lipoma consisting of mature adipose tissue and mature lamellar bone. The presence of non-fatty elements may lead to a wide differential diagnosis on radiology including benign and malignant lipomatous and nonlipomatous entities. The pathological diagnosis is also confounded by the presence of heterologous differentiation. Fortunately, most lipomas harbor classic cytogenetic aberrations, and the finding of translocations involving 12q13-15 may aid in the correct diagnosis. We report three cases of osteolipoma with radiological, histological, and cytogenetic correlation.
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- 2012
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15. False-negative fluorine-18 fluorodeoxyglucose positron emission tomography of a malignant peripheral nerve sheath tumor arising from a plexiform neurofibroma in the setting of neurofibromatosis type 1.
- Author
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Shahid KR, Amrami KK, Esther RJ, Lowe VJ, and Spinner RJ
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- Adult, Diagnosis, Differential, False Negative Reactions, Female, Humans, Magnetic Resonance Imaging, Nerve Sheath Neoplasms pathology, Neurofibroma, Plexiform pathology, Neurofibromatosis 1 diagnosis, Neurofibromatosis 1 diagnostic imaging, Radiopharmaceuticals, Fluorodeoxyglucose F18, Nerve Sheath Neoplasms diagnostic imaging, Neurofibroma, Plexiform diagnostic imaging, Neurofibromatosis 1 complications, Positron-Emission Tomography methods
- Abstract
Development of malignant peripheral nerve sheath tumors (MPNSTs) is a recognized complication in patients with neurofibromatosis type 1 (NF1). Differentiating benign from malignant lesions can be a difficult clinical problem. Positron emission tomography (PET) is an established method for making this differentiation with a high degree of sensitivity and specificity. There are several reports showing that fluorine-18 fluorodeoxyglucose (FDG) PET is an effective imaging modality for detecting malignant transformation with a sensitivity nearing 100%. There are very few reports of false-negative 18F-FDG PET in a patient with an MPNST. This case report describes a woman with NF1 and a grade 3 MPNST and a negative PET scan. Identification of malignant transformation in NF is a significant clinical challenge. It is important to recognize the potential limitations of 18F-FDG PET in these patients.
- Published
- 2011
16. Effect of NKISK on tendon lengthening: an in vivo model for various clinically applicable dosing regimens.
- Author
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Esther RJ, Creighton RA, Draeger RW, Weinhold PS, and Dahners LE
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- Animals, Biomechanical Phenomena, Drug Administration Schedule, Male, Rats, Rats, Sprague-Dawley, Contracture drug therapy, Oligopeptides administration & dosage, Patellar Ligament drug effects
- Abstract
One proposed mechanism of tendon lengthening is the "sliding fibril" hypothesis, in which tendons lengthen through the sliding of discontinuous fibrils after release of decorin-fibronectin interfibrillar bonds. The pentapeptide NKISK has been reported to inhibit the binding of decorin, a proteoglycan on the surface of collagen fibrils, to fibronectin, a tissue adhesion molecule, which are thought to play a role in interfibrillar binding. Prior investigations have demonstrated that NKISK produces in vivo tendon lengthening. This study investigates the effect of potential clinically applicable NKISK injection regimens in an in vivo model. One hundred and thirteen male Sprague-Dawley rats were divided into 15 different treatment groups, each receiving percutaneous patellar tendon injections of NKISK, QKTSK (a "nonsense" pentapeptide), or PBS of varying volumes, concentrations, and injection schedules. Following sacrifice, the patellar tendon lengths were measured in all groups, and biomechanical testing was performed with comparisons made to the contralateral, untreated control limbs. Tendon lengthening was significantly greater (p < or = 0.05) in nearly all NKISK-treated tendons as compared to PBS- and QKTSK-treated tendons and was dose-dependent. Measured lengthening was less in rats whose sacrifice was delayed following the final injection of NKISK, which likely indicates recontraction of lengthened tendons, but they remained significantly longer than the controls. Biomechanical testing did not reveal significant differences in ultimate load, modulus, stiffness, or displacement. This study demonstrates that NKISK given in clinically plausible dosing regimens produces dose-dependent tendon lengthening in an in vivo setting with minimal effects on the mechanical properties of the treated tendons.
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- 2008
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17. Follow-up study of long-term survivors of osteosarcoma in the prechemotherapy era.
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Gaffney R, Unni KK, Sim FH, Slezak JM, Esther RJ, and Bolander ME
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- Age Distribution, Bone Neoplasms mortality, Bone Neoplasms surgery, Female, Follow-Up Studies, Humans, Male, Minnesota epidemiology, Neoplasms, Second Primary mortality, Neoplasms, Second Primary pathology, Osteosarcoma mortality, Osteosarcoma surgery, Retrospective Studies, Survival Rate, Bone Neoplasms pathology, Osteosarcoma pathology, Survivors statistics & numerical data
- Abstract
Osteosarcoma is the most common primary bone sarcoma. Several studies published in the 1960s established that approximately one fifth of patients survive when treated with surgery alone. There is no information, however, about the long-term consequences of osteosarcoma. It is especially relevant to know if these patients are at risk for a second malignancy. We reviewed all clinical records from long-term (defined as more than 10 years) osteosarcoma survivors treated at Mayo Clinic in the prechemotherapeutic era from 1900 to 1960. We re-reviewed histological sections for most cases. Patients or next of kin provided follow-up information during telephone interviews. Rates of second malignancy were compared with expected rates in the population at large. We identified 465 patients treated for osteosarcoma. Of these patients, 83 (17.8%) were long-term survivors, including 19 who were alive up to 65 years after treatment. Of the 7 patients with pulmonary metastases, 3 died. A second malignancy developed in 26 patients, 15 of whom died of the malignancy. Although long-term survivors of osteosarcoma have a higher incidence of a second malignant tumor than a normal population, this increase was not statistically significant. No demographic or histological variables predicted long-term survival.
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- 2006
- Full Text
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18. Hardware removal: indications and expectations.
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Busam ML, Esther RJ, and Obremskey WT
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- Fracture Fixation, Intramedullary, Humans, Hypersensitivity, Metals immunology, Tibial Fractures surgery, Device Removal adverse effects, Device Removal methods, Fracture Fixation, Internal, Prostheses and Implants
- Abstract
Although hardware removal is commonly done, it should not be considered a routine procedure. The decision to remove hardware has significant economic implications, including the costs of the procedure as well as possible work time lost for postoperative recovery. The clinical indications for implant removal are not well established. There are few definitive data to guide whether implant removal is appropriate. Implant removal may be challenging and lead to complications, such as neurovascular injury, refracture, or recurrence of deformity. When implants are removed for pain relief alone, the results are unpredictable and depend on both the implant type and its anatomic location. Current literature does not support the routine removal of implants to protect against allergy, carcinogenesis, or metal detection. Surgeons and patients should be aware of appropriate indications and have realistic expectations of the risks and benefits of implant removal.
- Published
- 2006
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19. Foot tumors: diagnosis and treatment.
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Bos GD, Esther RJ, and Woll TS
- Subjects
- Foot anatomy & histology, Humans, Orthopedic Procedures methods, Bone Neoplasms diagnosis, Bone Neoplasms surgery, Soft Tissue Neoplasms diagnosis, Soft Tissue Neoplasms surgery
- Abstract
Several large clinical series have demonstrated that benign and malignant tumors occur in the foot and ankle at a much higher rate than previously thought. Vigilance is warranted in investigating any foot mass, including those with an apparently indolent course. Although tumors in the foot tend to produce symptoms relatively early because of the foot's compact structure, many tumors are initially misdiagnosed. Given the comparatively small size of the anatomic compartments in the foot, tumors often present outside the original compartment, making timely diagnosis essential. Major treatment errors can be avoided if physicians consider the potential for malignancy when evaluating all foot masses. A high index of suspicion, an organized approach to diagnosis, and evaluation of and adherence to the basic principles of treatment of musculoskeletal neoplasms increase the likelihood of acceptable results.
- Published
- 2002
- Full Text
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20. Management of metastatic disease of other bones.
- Author
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Esther RJ and Bos GD
- Subjects
- Aged, Aged, 80 and over, Bone Neoplasms diagnostic imaging, Female, Humans, Male, Middle Aged, Orthopedic Procedures, Radiography, Radionuclide Imaging, Bone Neoplasms secondary, Bone Neoplasms surgery
- Abstract
Metastases to the scapula and distal sites on the upper and lower extremities are infrequent. Although these metastases tend to occur in patients with advanced disease, a distal metastasis is occasionally the sole metastatic location. Distal metastases do not pose an immediate threat to a patient's life; however, they may cause significant pain and disability. Appropriate management can considerably enhance function, quality of life, and, occasionally, survival. Seven cases of distal metastasis are presented in this article with discussion of operative and nonoperative approaches to management.
- Published
- 2000
- Full Text
- View/download PDF
21. Marjolin ulcers: secondary carcinomas in chronic wounds.
- Author
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Esther RJ, Lamps L, and Schwartz HS
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- Aged, Burns pathology, Carcinoma, Squamous Cell pathology, Carcinoma, Squamous Cell surgery, Cell Transformation, Neoplastic, Chronic Disease, Fatal Outcome, Female, Humans, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Staging, Pressure Ulcer pathology, Retrospective Studies, Skin Neoplasms pathology, Skin Neoplasms surgery, Time Factors, Burns complications, Carcinoma, Squamous Cell etiology, Pressure Ulcer complications, Skin Neoplasms etiology
- Abstract
Marjolin ulcers are malignant tumors arising in chronic wounds. Strictly defined, they include carcinomas that transform from the chronic open wounds of pressure sores or burn scars. They behave aggressively and have a propensity for local recurrence and lymph node metastases. A retrospective study was done at a single institution identifying six individuals who had chronic wound ulcers that underwent malignant transformation into a carcinoma. Sinus tract degeneration in osteomyelitis was not included. The average latency time between ulcer formation and documentation of a malignancy was 30 years. All wounds were about the pelvis or flank. Major oncologic surgical procedures were done in an attempt to eradicate the cancer. High-grade tumors had positive lymph node metastases, portending a grave prognosis. All four individuals with nodal metastases eventually died of systemic disease. Early recognition and proper staging offers the best chance for cure.
- Published
- 1999
22. Use of physical restraints in a nineteenth-century state hospital.
- Author
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Esther RJ
- Subjects
- History, 19th Century, Humans, United States, Custodial Care history, Hospitals, Psychiatric history, Patients history, Restraint, Physical
- Abstract
Archival records of physical restraint usage at the St. Louis Insane Asylum (now the St. Louis State Hospital) were examined from January through June 1885. The demographics of restrained patients were determined from archival admission records. In the 6-month (181-day) sample period, 53 patients accounted for the total of 2,537 incidents of night restraint. Sixty percent of the restrained patients were women and 53% were immigrants. By far most (98.5%) of the incidents of restraint were brought on by violent behaviour (fighting, destroying property, injury to self) while most incidents in modern hospitals result from verbal threats or shouting. When these records were combined with day restraint records from the same 6-month period in 1889, an overall incidence rate of 9.7% per month was estimated. This is similar to rates reported from modern psychiatric hospitals. Possible reasons for the discrepancies and similarities in the types of patients restrained and the activities which brought on restraint in the nineteenth and twentieth centuries are discussed.
- Published
- 1997
- Full Text
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23. Differential antigen preservation during tissue autolysis.
- Author
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Pelstring RJ, Allred DC, Esther RJ, Lampkin SR, and Banks PM
- Subjects
- Antigens, CD immunology, Biopsy, Humans, Immunohistochemistry methods, Keratins immunology, Lymph Nodes metabolism, Lymph Nodes pathology, Membrane Glycoproteins immunology, Mucin-1, Necrosis immunology, Necrosis pathology, Vimentin immunology, Antigens analysis, Autolysis, Lymph Nodes immunology, Tissue Preservation
- Abstract
Immediate fixation or snap freezing of tissue is ordinarily done to maximize antigen preservation for immunocytochemistry; however, delay in tissue allocation or spontaneous lymph node infarction can render tissue suboptimal for immunostaining. To test the effects of tissue autolysis/necrosis on the preservation of various lymphoid, epithelial, and mesenchymal markers, two lymph nodes (one with reactive lymphoid hyperplasia and one with metastatic ductal breast carcinoma) were evaluated for immunocytochemically demonstrated antigen preservation at 0-, 4-, 8-, 12-, 24-, 48-, and 72-hour intervals of autolysis at 37 degrees C. All specimens were stained by frozen section and formalin-fixed paraffin section immunocytochemical reactions with antibodies against CLA (CD45), UCHL-1 (CD45RO), L-26, kappa, lambda, anti-epithelial keratins (AE-1 and AE-3), epithelial membrane antigen, and vimentin. Frozen sections were additionally stained for Leu-1 (CD5), Leu-2a (CD8), Leu-3a+b (CD4), Leu-4 (CD3), and Leu-14 (CD22). The most resilient lymphoid antigen preservation was observed with CLA and UCHL-1, both exhibiting immunoreactivity at 72 hours in both frozen and fixed preparations. L-26 showed similar reactivity in frozen sections, but detectable antigen was observed only up to 24 hours in formalin-fixed tissue. Leu-2a proved to be the most labile antigen, persisting for only 12 hours in frozen sections. The epithelial markers epithelial membrane antigen and AE-1 exhibited excellent antigenic preservation in both frozen and fixed preparations; AE-3 persisted well in frozen section but was not demonstrated in fixed tissue. Vimentin immunoreactivity was vastly superior in frozen, as compared with fixed, tissue sections. Most antigens showed remarkable preservation despite morphologic degradation; however, differential antigenic resilience was demonstrated. Knowledge of this variation in antigen decay is critical for evaluation of immunoperoxidase phenotypic studies of autolyzed or necrotic tissue.
- Published
- 1991
- Full Text
- View/download PDF
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