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Eward, William Curtis

Overview:

I am an Orthopaedic Oncologist, with dual clinical degrees (MD and DVM).  I treat complex sarcomas in people and animals.  My laboratory studies comparative oncology - discoveries we can make about cancer by analyses across different species.

Positions:

Assistant Professor of Orthopaedic Surgery

Orthopaedics
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2006

M.D. — University of Vermont College of Medicine

News:

Grants:

Intraoperative detection and ablation of microscopic residual cancer in the tumor bed

Administered By
Orthopaedics
AwardedBy
Lumicell Diagnostics
Role
Principal Investigator
Start Date
September 01, 2013
End Date
May 31, 2016

Engineered imaging nanoparticles for real-time detection of cancer in the tumor bed

Administered By
Orthopaedics
AwardedBy
Lumicell Diagnostics
Role
Investigator
Start Date
September 01, 2013
End Date
January 31, 2015

Intraoperative detection and ablation of microscopic residual cancer in the tumor bed

Administered By
Orthopaedics
AwardedBy
Lumicell Diagnostics
Role
Principal Investigator
Start Date
September 01, 2013
End Date
September 30, 2014

Awards:

Hyundai Hope on Wheels. Hyundai Hope on Wheels.

Type
National
Awarded By
Hyundai Hope on Wheels
Date
January 01, 2017

Publications:

The stability of the hip after the use of a proximal femoral endoprosthesis for oncological indications: analysis of variables relating to the patient and the surgical technique.

Instability of the hip is the most common mode of failure after reconstruction with a proximal femoral arthroplasty (PFA) using an endoprosthesis after excision of a tumour. Small studies report improved stability with capsular repair of the hip and other techniques, but these have not been investigated in a large series of patients. The aim of this study was to evaluate variables associated with the patient and the operation that affect post-operative stability. We hypothesised an association between capsular repair and stability.In a retrospective cohort study, we identified 527 adult patients who were treated with a PFA for tumours. Our data included demographics, the pathological diagnosis, the amount of resection of the abductor muscles, the techniques of reconstruction and the characteristics of the implant. We used regression analysis to compare patients with and without post-operative instability.A total of 20 patients out of 527 (4%) had instability which presented at a mean of 35 days (3 to 131) post-operatively. Capsular repair was not associated with a reduced rate of instability. Bivariate analysis showed that a posterolateral surgical approach (odds ratio (OR) 0.11, 95% confidence interval (CI) 0.02 to 0.86) and the type of implant (p = 0.046) had a significant association with reduced instability; age > 60 years predicted instability (OR 3.17, 95% CI 1.00 to 9.98). Multivariate analysis showed age > 60 years (OR 5.09, 95% CI 1.23 to 21.07), female gender (OR 1.73, 95% CI 1.04 to 2.89), a malignant primary bone tumour (OR 2.04, 95% CI 1.06 to 3.95), and benign condition (OR 5.56, 95% CI 1.35 to 22.90), but not metastatic disease or soft-tissue tumours, predicted instability, while a posterolateral approach (OR 0.09, 95% CI 0.01 to 0.53) was protective against instability. No instability occurred when a synthetic graft was used in 70 patients.Stability of the hip after PFA is influenced by variables associated with the patient, the pathology, the surgical technique and the implant. We did not find an association between capsular repair and improved stability. Extension of the tumour often dictates surgical technique; however, our results indicate that PFA using a posterolateral approach with a hemiarthroplasty and synthetic augment for soft-tissue repair confers the lowest risk of instability. Patients who are elderly, female, or with a primary benign or malignant bone tumour should be counselled about an increased risk of instability. Cite this article: Bone Joint J 2017;99-B:531-7.

Authors
Henderson, ER; Keeney, BJ; Pala, E; Funovics, PT; Eward, WC; Groundland, JS; Ehrlichman, LK; Puchner, SSE; Brigman, BE; Ready, JE; Temple, HT; Ruggieri, P; Windhager, R; Letson, GD; Hornicek, FJ
MLA Citation
Henderson, ER, Keeney, BJ, Pala, E, Funovics, PT, Eward, WC, Groundland, JS, Ehrlichman, LK, Puchner, SSE, Brigman, BE, Ready, JE, Temple, HT, Ruggieri, P, Windhager, R, Letson, GD, and Hornicek, FJ. "The stability of the hip after the use of a proximal femoral endoprosthesis for oncological indications: analysis of variables relating to the patient and the surgical technique." The bone & joint journal 99-B.4 (April 2017): 531-537.
PMID
28385944
Source
epmc
Published In
Bone and Joint Journal
Volume
99-B
Issue
4
Publish Date
2017
Start Page
531
End Page
537
DOI
10.1302/0301-620x.99b4.bjj-2016-0960.r1

Mesenchymal-Epithelial Transition in Sarcomas Is Controlled by the Combinatorial Expression of MicroRNA 200s and GRHL2.

Phenotypic plasticity involves a process in which cells transiently acquire phenotypic traits of another lineage. Two commonly studied types of phenotypic plasticity are epithelial-mesenchymal transition (EMT) and mesenchymal-epithelial transition (MET). In carcinomas, EMT drives invasion and metastatic dissemination, while MET is proposed to play a role in metastatic colonization. Phenotypic plasticity in sarcomas is not well studied; however, there is evidence that a subset of sarcomas undergo an MET-like phenomenon. While the exact mechanisms by which these transitions occur remain largely unknown, it is likely that some of the same master regulators that drive EMT and MET in carcinomas also act in sarcomas. In this study, we combined mathematical models with bench experiments to identify a core regulatory circuit that controls MET in sarcomas. This circuit comprises the microRNA 200 (miR-200) family, ZEB1, and GRHL2. Interestingly, combined expression of miR-200s and GRHL2 further upregulates epithelial genes to induce MET. This effect is phenocopied by downregulation of either ZEB1 or the ZEB1 cofactor, BRG1. In addition, an MET gene expression signature is prognostic for improved overall survival in sarcoma patients. Together, our results suggest that a miR-200, ZEB1, GRHL2 gene regulatory network may drive sarcoma cells to a more epithelial-like state and that this likely has prognostic relevance.

Authors
Somarelli, JA; Shetler, S; Jolly, MK; Wang, X; Bartholf Dewitt, S; Hish, AJ; Gilja, S; Eward, WC; Ware, KE; Levine, H; Armstrong, AJ; Garcia-Blanco, MA
MLA Citation
Somarelli, JA, Shetler, S, Jolly, MK, Wang, X, Bartholf Dewitt, S, Hish, AJ, Gilja, S, Eward, WC, Ware, KE, Levine, H, Armstrong, AJ, and Garcia-Blanco, MA. "Mesenchymal-Epithelial Transition in Sarcomas Is Controlled by the Combinatorial Expression of MicroRNA 200s and GRHL2." Molecular and cellular biology 36.19 (October 2016): 2503-2513.
Website
http://hdl.handle.net/10161/13882
PMID
27402864
Source
epmc
Published In
Molecular and Cellular Biology
Volume
36
Issue
19
Publish Date
2016
Start Page
2503
End Page
2513
DOI
10.1128/mcb.00373-16

Simultaneous Primary Presacral Myelolipomas: Case Report and Review of the Literature.

Authors
Lazarides, AL; Scott, EJ; Cardona, DM; Blazer, DG; Brigman, BE; Eward, WC
MLA Citation
Lazarides, AL, Scott, EJ, Cardona, DM, Blazer, DG, Brigman, BE, and Eward, WC. "Simultaneous Primary Presacral Myelolipomas: Case Report and Review of the Literature." Journal of gastrointestinal cancer 47.3 (September 2016): 331-335.
PMID
26164122
Source
epmc
Published In
Journal of Gastrointestinal Cancer
Volume
47
Issue
3
Publish Date
2016
Start Page
331
End Page
335
DOI
10.1007/s12029-015-9749-5

A Novel Imaging System Distinguishes Neoplastic from Normal Tissue During Resection of Soft Tissue Sarcomas and Mast Cell Tumors in Dogs.

To assess the ability of a novel imaging system designed for intraoperative detection of residual cancer in tumor beds to distinguish neoplastic from normal tissue in dogs undergoing resection of soft tissue sarcoma (STS) and mast cell tumor (MCT).Non-randomized prospective clinical trial.12 dogs with STS and 7 dogs with MCT.A fluorescent imaging agent that is activated by proteases in vivo was administered to the dogs 4-6 or 24-26 hours before tumor resection. During surgery, a handheld imaging device was used to measure fluorescence intensity within the cancerous portion of the resected specimen and determine an intensity threshold for subsequent identification of cancer. Selected areas within the resected specimen and tumor bed were then imaged, and biopsies (n=101) were obtained from areas that did or did not have a fluorescence intensity exceeding the threshold. Results of intraoperative fluorescence and histology were compared.The imaging system correctly distinguished cancer from normal tissue in 93/101 biopsies (92%). Using histology as the reference, the sensitivity and specificity of the imaging system for identification of cancer in biopsies were 92% and 92%, respectively. There were 10/19 (53%) dogs which exhibited transient facial erythema soon after injection of the imaging agent which responded to but was not consistently prevented by intravenous diphenhydramine.A fluorescence-based imaging system designed for intraoperative use can distinguish canine soft tissue sarcoma (STS) and mast cell tumor (MCT) tissue from normal tissue with a high degree of accuracy. The system has potential to assist surgeons in assessing the adequacy of tumor resections during surgery, potentially reducing the risk of local tumor recurrence. Although responsive to antihistamines, the risk of hypersensitivity needs to be considered in light of the potential benefits of this imaging system in dogs.

Authors
Bartholf DeWitt, S; Eward, WC; Eward, CA; Lazarides, AL; Whitley, MJ; Ferrer, JM; Brigman, BE; Kirsch, DG; Berg, J
MLA Citation
Bartholf DeWitt, S, Eward, WC, Eward, CA, Lazarides, AL, Whitley, MJ, Ferrer, JM, Brigman, BE, Kirsch, DG, and Berg, J. "A Novel Imaging System Distinguishes Neoplastic from Normal Tissue During Resection of Soft Tissue Sarcomas and Mast Cell Tumors in Dogs." Veterinary surgery : VS 45.6 (August 2016): 715-722.
PMID
27281113
Source
epmc
Published In
Veterinary Surgery
Volume
45
Issue
6
Publish Date
2016
Start Page
715
End Page
722
DOI
10.1111/vsu.12487

Synovial Chondromatosis.

Authors
Neumann, JA; Garrigues, GE; Brigman, BE; Eward, WC
MLA Citation
Neumann, JA, Garrigues, GE, Brigman, BE, and Eward, WC. "Synovial Chondromatosis." JBJS reviews 4.5 (May 2016).
PMID
27490219
Source
epmc
Published In
JBJS Reviews
Volume
4
Issue
5
Publish Date
2016
DOI
10.2106/jbjs.rvw.o.00054

Myogenic transcription factors regulate pro-metastatic miR-182.

Approximately 30% of patients with soft-tissue sarcoma die from pulmonary metastases. The mechanisms that drive sarcoma metastasis are not well understood. Recently, we identified miR-182 as a driver of sarcoma metastasis in a primary mouse model of soft-tissue sarcoma. We also observed elevated miR-182 in a subset of primary human sarcomas that metastasized to the lungs. Here, we show that myogenic differentiation factors regulate miR-182 levels to contribute to metastasis in mouse models. We find that MyoD directly binds the miR-182 promoter to increase miR-182 expression. Furthermore, mechanistic studies revealed that Pax7 can promote sarcoma metastasis in vivo through MyoD-dependent regulation of pro-metastatic miR-182. Taken together, these results suggest that sarcoma metastasis can be partially controlled through Pax7/MyoD-dependent activation of miR-182 and provide insight into the role that myogenic transcription factors have in sarcoma progression.

Authors
Dodd, RD; Sachdeva, M; Mito, JK; Eward, WC; Brigman, BE; Ma, Y; Dodd, L; Kim, Y; Lev, D; Kirsch, DG
MLA Citation
Dodd, RD, Sachdeva, M, Mito, JK, Eward, WC, Brigman, BE, Ma, Y, Dodd, L, Kim, Y, Lev, D, and Kirsch, DG. "Myogenic transcription factors regulate pro-metastatic miR-182." Oncogene 35.14 (April 2016): 1868-1875.
PMID
26234681
Source
epmc
Published In
Oncogene: Including Oncogene Reviews
Volume
35
Issue
14
Publish Date
2016
Start Page
1868
End Page
1875
DOI
10.1038/onc.2015.252

Innovations in Intraoperative Tumor Visualization.

In the surgical management of solid tumors, adequacy of tumor resection has implications for local recurrence and survival. The standard method of intraoperative identification of tumor margin is frozen section pathologic analysis, which is time-consuming with potential for sampling error. Intraoperative tumor visualization has the potential to significantly improve surgical cancer care across disciplines, by guiding accuracy of biopsies, increasing adequacy of resections, directing adjuvant therapy, and even providing diagnostic information. We provide an outline of various methods of intraoperative tumor visualization developed to aid in the real-time assessment of tumor extent and adequacy of resection.

Authors
Visgauss, JD; Eward, WC; Brigman, BE
MLA Citation
Visgauss, JD, Eward, WC, and Brigman, BE. "Innovations in Intraoperative Tumor Visualization." The Orthopedic clinics of North America 47.1 (January 2016): 253-264.
PMID
26614939
Source
epmc
Published In
Orthopedic Clinics of North America
Volume
47
Issue
1
Publish Date
2016
Start Page
253
End Page
264
DOI
10.1016/j.ocl.2015.08.023

A mouse-human phase 1 co-clinical trial of a protease-activated fluorescent probe for imaging cancer.

Local recurrence is a common cause of treatment failure for patients with solid tumors. Intraoperative detection of microscopic residual cancer in the tumor bed could be used to decrease the risk of a positive surgical margin, reduce rates of reexcision, and tailor adjuvant therapy. We used a protease-activated fluorescent imaging probe, LUM015, to detect cancer in vivo in a mouse model of soft tissue sarcoma (STS) and ex vivo in a first-in-human phase 1 clinical trial. In mice, intravenous injection of LUM015 labeled tumor cells, and residual fluorescence within the tumor bed predicted local recurrence. In 15 patients with STS or breast cancer, intravenous injection of LUM015 before surgery was well tolerated. Imaging of resected human tissues showed that fluorescence from tumor was significantly higher than fluorescence from normal tissues. LUM015 biodistribution, pharmacokinetic profiles, and metabolism were similar in mouse and human subjects. Tissue concentrations of LUM015 and its metabolites, including fluorescently labeled lysine, demonstrated that LUM015 is selectively distributed to tumors where it is activated by proteases. Experiments in mice with a constitutively active PEGylated fluorescent imaging probe support a model where tumor-selective probe distribution is a determinant of increased fluorescence in cancer. These co-clinical studies suggest that the tumor specificity of protease-activated imaging probes, such as LUM015, is dependent on both biodistribution and enzyme activity. Our first-in-human data support future clinical trials of LUM015 and other protease-sensitive probes.

Authors
Whitley, MJ; Cardona, DM; Lazarides, AL; Spasojevic, I; Ferrer, JM; Cahill, J; Lee, C-L; Snuderl, M; Blazer, DG; Hwang, ES; Greenup, RA; Mosca, PJ; Mito, JK; Cuneo, KC; Larrier, NA; O'Reilly, EK; Riedel, RF; Eward, WC; Strasfeld, DB; Fukumura, D; Jain, RK; Lee, WD; Griffith, LG; Bawendi, MG; Kirsch, DG; Brigman, BE
MLA Citation
Whitley, MJ, Cardona, DM, Lazarides, AL, Spasojevic, I, Ferrer, JM, Cahill, J, Lee, C-L, Snuderl, M, Blazer, DG, Hwang, ES, Greenup, RA, Mosca, PJ, Mito, JK, Cuneo, KC, Larrier, NA, O'Reilly, EK, Riedel, RF, Eward, WC, Strasfeld, DB, Fukumura, D, Jain, RK, Lee, WD, Griffith, LG, Bawendi, MG, Kirsch, DG, and Brigman, BE. "A mouse-human phase 1 co-clinical trial of a protease-activated fluorescent probe for imaging cancer." Science translational medicine 8.320 (January 2016): 320ra4-.
PMID
26738797
Source
epmc
Published In
Science Translational Medicine
Volume
8
Issue
320
Publish Date
2016
Start Page
320ra4
DOI
10.1126/scitranslmed.aad0293

A Fluorescence-Guided Laser Ablation System for Removal of Residual Cancer in a Mouse Model of Soft Tissue Sarcoma.

The treatment of soft tissue sarcoma (STS) generally involves tumor excision with a wide margin. Although advances in fluorescence imaging make real-time detection of cancer possible, removal is limited by the precision of the human eye and hand. Here, we describe a novel pulsed Nd:YAG laser ablation system that, when used in conjunction with a previously described molecular imaging system, can identify and ablate cancer in vivo. Mice with primary STS were injected with the protease-activatable probe LUM015 to label tumors. Resected tissues from the mice were then imaged and treated with the laser using the paired fluorescence-imaging/ laser ablation device, generating ablation clefts with sub-millimeter precision and minimal underlying tissue damage. Laser ablation was guided by fluorescence to target tumor tissues, avoiding normal structures. The selective ablation of tumor implants in vivo improved recurrence-free survival after tumor resection in a cohort of 14 mice compared to 12 mice that received no ablative therapy. This prototype system has the potential to be modified so that it can be used during surgery to improve recurrence-free survival in patients with cancer.

Authors
Lazarides, AL; Whitley, MJ; Strasfeld, DB; Cardona, DM; Ferrer, JM; Mueller, JL; Fu, HL; Bartholf DeWitt, S; Brigman, BE; Ramanujam, N; Kirsch, DG; Eward, WC
MLA Citation
Lazarides, AL, Whitley, MJ, Strasfeld, DB, Cardona, DM, Ferrer, JM, Mueller, JL, Fu, HL, Bartholf DeWitt, S, Brigman, BE, Ramanujam, N, Kirsch, DG, and Eward, WC. "A Fluorescence-Guided Laser Ablation System for Removal of Residual Cancer in a Mouse Model of Soft Tissue Sarcoma." Theranostics 6.2 (January 2016): 155-166.
Website
http://hdl.handle.net/10161/13883
PMID
26877775
Source
epmc
Published In
Theranostics
Volume
6
Issue
2
Publish Date
2016
Start Page
155
End Page
166
DOI
10.7150/thno.13536

Epidemiology and Diagnosis of Ipsilateral Femoral Neck and Shaft Fractures: A Systematic Review of 1761 cases in 1758 Patients (1990-2015)

Authors
Barquet, A; Barrios, E; Garau, M; Zura, RD; Eward, WC
MLA Citation
Barquet, A, Barrios, E, Garau, M, Zura, RD, and Eward, WC. "Epidemiology and Diagnosis of Ipsilateral Femoral Neck and Shaft Fractures: A Systematic Review of 1761 cases in 1758 Patients (1990-2015)." Trauma Cases and Reviews 1.015 (November 14, 2015): 1-7.
Website
http://hdl.handle.net/10161/11694
Source
manual
Published In
Trauma Cases and Reviews
Volume
1
Issue
015
Publish Date
2015
Start Page
1
End Page
7

The use of radiation therapy in localized high-grade soft tissue sarcoma and potential impact on survival.

It is a consensus that radiation therapy (RT) should be applied for all large, deep, high-grade soft tissue sarcomas (STS). Therefore, we investigated the National Cancer Database (NCDB) to study how these guidelines are being followed, to determine what factors may be associated with the decision not to use RT, and to see whether there was an association of RT use and survival.We retrospectively analyzed localized high-grade STS patients in the NCDB from 1998 through 2006. They were further stratified into two groups: no radiation (NRT) group and radiation (RT) group. Then, long-term survival between the two groups was evaluated using the Kaplan-Meier (KM) method with comparisons based on the log-rank test. Multiple variables were analyzed between the two groups. Propensity matching was performed secondarily to minimize the influence of confounding variables.A total of 3982 of 10,290 patients (37.8 %) did not receive RT and 6,308 patients (62.2 %) did receive RT. Patients in the NRT group were more likely to have a below-median education level (median 58.2 % vs. 60.7 %; p = 0.015) and a below-median income level (65.1 % vs. 68.6 %; p < 0.001). In addition, these patients lived farther from their treatment centers (20.2 vs. 14.8 miles, p = 0.002) and were more likely to be uninsured (5.3 % vs. 3.5 %, p < 0.001). They were less likely to receive a radical excision (55.2 % vs. 70.1 %; p < 0.001) and more likely to receive amputation (20.9 % vs. 3.3 %; p < 0.001). The 30-day mortality (1.2 % vs. 0.2 %; p < 0.001) and readmission rate (3.8 % vs. 2.8 %; p = 0.031) were higher for the NRT group. KM analysis showed that long-term survival for patients who did not receive RT was significantly lower, even after propensity score matching (p < 0.001).This large database review reveals a striking lack of utilization of RT to treat high-grade STS, which correlates with poorer survival even after propensity matching. Lower education and income levels and diminished access to medical care (insurance and distance to the facility) are associated with failing to receive RT.

Authors
Hou, C-H; Lazarides, AL; Speicher, PJ; Nussbaum, DP; Blazer, DG; Kirsch, DG; Brigman, BE; Eward, WC
MLA Citation
Hou, C-H, Lazarides, AL, Speicher, PJ, Nussbaum, DP, Blazer, DG, Kirsch, DG, Brigman, BE, and Eward, WC. "The use of radiation therapy in localized high-grade soft tissue sarcoma and potential impact on survival." Annals of surgical oncology 22.9 (September 2015): 2831-2838.
PMID
26040605
Source
epmc
Published In
Annals of Surgical Oncology
Volume
22
Issue
9
Publish Date
2015
Start Page
2831
End Page
2838
DOI
10.1245/s10434-015-4639-4

Abstract SY36-03: Intraoperative molecular imaging with protease-activated fluorescent imaging agents

Authors
Whitley, MJ; Cardona, DM; Blazer, DG; Hwang, S; Greenup, RA; Mosca, PJ; Cahill, J; Mito, JK; Cuneo, KC; Larrier, N; O'Reilly, E; Spasojevic, I; Riedel, RF; Eward, WC; Griffith, LG; Bawendi, MG; Ferrer, J; Strasfeld, DB; Lee, WD; Brigman, B; Kirsch, DG
MLA Citation
Whitley, MJ, Cardona, DM, Blazer, DG, Hwang, S, Greenup, RA, Mosca, PJ, Cahill, J, Mito, JK, Cuneo, KC, Larrier, N, O'Reilly, E, Spasojevic, I, Riedel, RF, Eward, WC, Griffith, LG, Bawendi, MG, Ferrer, J, Strasfeld, DB, Lee, WD, Brigman, B, and Kirsch, DG. "Abstract SY36-03: Intraoperative molecular imaging with protease-activated fluorescent imaging agents." August 1, 2015.
Source
crossref
Published In
Cancer Research
Volume
75
Issue
15 Supplement
Publish Date
2015
Start Page
SY36-03
End Page
SY36-03
DOI
10.1158/1538-7445.AM2015-SY36-03

Histological Evaluation of Tendon-Bone Healing of an Anterior Cruciate Ligament Hamstring Graft in a 14-Year-Old Boy.

Authors
Lazarides, AL; Eward, WC; Green, K; Cardona, DM; Brigman, BE; Taylor, DC
MLA Citation
Lazarides, AL, Eward, WC, Green, K, Cardona, DM, Brigman, BE, and Taylor, DC. "Histological Evaluation of Tendon-Bone Healing of an Anterior Cruciate Ligament Hamstring Graft in a 14-Year-Old Boy." The American journal of sports medicine 43.8 (August 2015): 1935-1940.
PMID
25968884
Source
epmc
Published In
American Journal of Sports Medicine
Volume
43
Issue
8
Publish Date
2015
Start Page
1935
End Page
1940
DOI
10.1177/0363546515584040

Comparison of Acute Histologic and Biomechanical Effects of Radiofrequency Ablation and Cryoablation on Periarticular Structures in a Swine Model.

To compare the acute effects of radiofrequency (RF) ablation and cryoablation on the structural integrity of nontarget periarticular tissues that may be placed at risk during percutaneous bone ablation.RF ablation and cryoablation were separately performed on tendon, articular cartilage, and ligament in an ex vivo porcine model by using standard bone ablation protocols. Gross and histopathologic analysis was performed on cartilage and tendon (n = 6 for each treatment group, n = 5 controls). Tendon lengths were measured before and after ablation. Biomechanical tensile testing was performed on each ligament sample after ablation, with quantification of ultimate load at failure and linear stiffness (n = 7 ligaments in treatment and control groups).RF ablation and cryoablation injured chondrocytes within the ablation zones but caused minimal effects on gross and histologic cartilage architecture. Cryoablation resulted in minimal gross and histologic effects on tendon whereas RF ablation resulted in marked disruption of collagen fibers and significant longitudinal shortening (P = .002). Similarly, cryoablation did not alter ligament strength or stiffness compared with control, whereas RF ablation resulted in a significant decrease in tensile strength and stiffness compared with control and cryoablation samples (P < .001).Neither RF ablation nor cryoablation resulted in significant acute changes in cartilage architecture. However, RF ablation resulted in marked disruption of tendon architecture, tendon shortening, ligament weakening, and loss of ligament stiffness, whereas cryoablation had no significant effect on any of these parameters. These findings suggest that cryoablation may have fewer negative acute effects than RF ablation, although long-term outcomes are currently unknown.

Authors
Vikingstad, EM; de Ridder, GG; Glisson, RR; Cardona, DM; DiPalma, D; Eward, WC; Brigman, BE; Nelson, RC; Kim, CY
MLA Citation
Vikingstad, EM, de Ridder, GG, Glisson, RR, Cardona, DM, DiPalma, D, Eward, WC, Brigman, BE, Nelson, RC, and Kim, CY. "Comparison of Acute Histologic and Biomechanical Effects of Radiofrequency Ablation and Cryoablation on Periarticular Structures in a Swine Model." Journal of vascular and interventional radiology : JVIR 26.8 (August 2015): 1221-1228.e1.
PMID
26065927
Source
epmc
Published In
JVIR: Journal of Vascular and Interventional Radiology
Volume
26
Issue
8
Publish Date
2015
Start Page
1221
End Page
1228.e1
DOI
10.1016/j.jvir.2015.04.013

Impact of liposomal bupivacaine administration on postoperative pain in patients undergoing total knee replacement.

To determine whether liposomal bupivacaine, a long-acting anesthetic indicated for single-dose wound infiltration to produce postoperative analgesia, has an impact on postoperative pain in patients undergoing total knee arthroplasties (TKAs).Single-center retrospective cohort study.Large tertiary and quaternary care hospital.A total of 120 adults who underwent TKA between March 1, 2013, and October 31, 2013; of those patients, 55 patients received an intraoperative dose of liposomal bupivacaine 266 mg (active treatment group), and 65 did not receive the drug (control group).The primary end point was the mean area under the curve (AUC) of numeric rating scale (NRS) pain scores from the end of surgery to 48 hours after surgery. Secondary end points included measures of postoperative pain up to 24 hours after surgery, opioid consumption within 48 hours after surgery, duration of hospitalization, and ambulation distance from the end of surgery to discharge. No significant differences were noted in the primary or secondary end points between patients who received or did not receive an intraoperative dose of liposomal bupivacaine. The mean ± SD AUC of NRS pain scores was 199.59 ± 67.11 and 192.94 ± 70.41 for the liposomal bupivacaine and control groups, respectively (p=0.658). Use of adjunctive analgesics was higher among patients in the control group, particularly for those receiving celecoxib, pregabalin, and continuous regional ropivacaine infusions, which may have minimized any differences in pain control between the treatment groups.Liposomal bupivacaine did not improve pain control in patients undergoing TKA when compared with historical management strategies; however, differences may have been obscured by increased utilization of adjunctive analgesics among patients in the control group.

Authors
White, S; Vaughan, C; Raiff, D; Eward, W; Bolognesi, M
MLA Citation
White, S, Vaughan, C, Raiff, D, Eward, W, and Bolognesi, M. "Impact of liposomal bupivacaine administration on postoperative pain in patients undergoing total knee replacement." Pharmacotherapy 35.5 (May 4, 2015): 477-481.
PMID
25940854
Source
epmc
Published In
Pharmacotherapy
Volume
35
Issue
5
Publish Date
2015
Start Page
477
End Page
481
DOI
10.1002/phar.1587

A Phase I Clinical Trial of LUM015: A Protease-activated Fluorescent Imaging Agent to Detect Cancer during Surgery

Authors
Whitley, MJ; Cardona, DM; Blazer, DG; Hwang, E; Greenup, RA; Mosca, PJ; Cahill, J; Mito, JK; Cuneo, KC; Larrier, N; O'Reilly, E; Spasojevic, I; Riedel, RF; Eward, WC; Griffith, LG; Bawendi, MG; Kirsch, DG; Brigman, BE
MLA Citation
Whitley, MJ, Cardona, DM, Blazer, DG, Hwang, E, Greenup, RA, Mosca, PJ, Cahill, J, Mito, JK, Cuneo, KC, Larrier, N, O'Reilly, E, Spasojevic, I, Riedel, RF, Eward, WC, Griffith, LG, Bawendi, MG, Kirsch, DG, and Brigman, BE. "A Phase I Clinical Trial of LUM015: A Protease-activated Fluorescent Imaging Agent to Detect Cancer during Surgery." February 2015.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
22
Publish Date
2015
Start Page
S11
End Page
S12

The Use of Radiation Therapy in Well-Differentiated Soft Tissue Sarcoma of the Extremities: An NCDB Review.

Objective. This study investigated patterns of utilization of radiation therapy (RT) and correlated this with overall survival by assessing patients with well-differentiated soft tissue sarcoma of the extremity (STS-E) in the National Cancer Database (NCDB). Methods. All patients diagnosed with well-differentiated STS-E between 1998 and 2006 were identified in the NCDB. Patients were stratified by use of surgery alone versus use of adjuvant RT after surgery and analyzed using multivariate analysis, Kaplan-Meier analysis, and propensity matching. Results. 2113 patients with well-differentiated STS-E were identified in the NCDB for inclusion with a mean follow-up time of 74 months. 69% of patients were treated with surgery alone, while 26% were treated with surgery followed by adjuvant RT. Patients undergoing amputation were less likely to receive adjuvant RT. There was no difference in overall survival between patients with well-differentiated STS treated with surgery alone and those patients who received adjuvant RT. Conclusions. In the United States, adjuvant RT is being utilized in a quarter of patients being treated for well-differentiated STS-E. While the use of adjuvant RT may be viewed as a means to facilitate limb salvage, this large national database review confirms no survival benefit, regardless of tumor size or margin status.

Authors
Lazarides, AL; Eward, WC; Speicher, PJ; Hou, C-H; Nussbaum, DP; Green, C; Blazer, DG; Kirsch, DG; Brigman, BE
MLA Citation
Lazarides, AL, Eward, WC, Speicher, PJ, Hou, C-H, Nussbaum, DP, Green, C, Blazer, DG, Kirsch, DG, and Brigman, BE. "The Use of Radiation Therapy in Well-Differentiated Soft Tissue Sarcoma of the Extremities: An NCDB Review." Sarcoma 2015 (January 2015): 186581-.
PMID
26064077
Source
epmc
Published In
Sarcoma
Volume
2015
Publish Date
2015
Start Page
186581
DOI
10.1155/2015/186581

Extranodal Castleman disease of the extremities: a case report and review of the literature.

Castleman disease is a rare lymphoproliferative disorder of unknown etiology that most commonly presents as a mediastinal nodal mass or, in the extranodal form of the disease, a mass located in the mediastinum or retroperitoneum. It is exceptionally uncommon for Castleman disease to present in the extremities. We report a rare case of extranodal Castleman disease presenting as a muscular forearm mass. We compare our case with the seven other reported cases in which Castleman disease presented as an isolated soft tissue mass in the extremities.

Authors
Eward, WC; DeWitt, SB; Brigman, BE; Kontogeorgakos, V; Lagoo, AS
MLA Citation
Eward, WC, DeWitt, SB, Brigman, BE, Kontogeorgakos, V, and Lagoo, AS. "Extranodal Castleman disease of the extremities: a case report and review of the literature." Skeletal radiology 43.11 (November 2014): 1627-1631.
PMID
24970669
Source
epmc
Published In
Skeletal Radiology
Volume
43
Issue
11
Publish Date
2014
Start Page
1627
End Page
1631
DOI
10.1007/s00256-014-1945-z

Custom facial reconstruction for osteosarcoma of the jaw.

Osteosarcoma accounts for most primary bone cancers in children and young adults. High-grade lesions are typically managed with a combination of chemotherapy and wide-margin surgical excision. Although this malignancy typically affects the metaphyseal region of long bones, it also can be seen in the axial skeleton. Of axial locations, tumors in the head and neck can be particularly troubling to treat. Segmental bone loss after resection of malignant mandibular tumors continues to present important challenges to the reconstructive surgeon. Recent advancements in 3-dimensional modeling have facilitated custom templates for patient-specific reconstructions. This report describes the case of a young woman with osteosarcoma of the mandible undergoing customized template composite facial reconstruction using a vascularized osteoseptocutaneous fibula flap.

Authors
Lazarides, A; Erdmann, D; Powers, D; Eward, W
MLA Citation
Lazarides, A, Erdmann, D, Powers, D, and Eward, W. "Custom facial reconstruction for osteosarcoma of the jaw." Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 72.11 (November 2014): 2375.e1-2375.10.
PMID
25438280
Source
epmc
Published In
Journal of Oral and Maxillofacial Surgery
Volume
72
Issue
11
Publish Date
2014
Start Page
2375.e1
End Page
2375.10
DOI
10.1016/j.joms.2014.07.018

The effect of the setting of a positive surgical margin in soft tissue sarcoma.

BACKGROUND: The objectives of this study were to evaluate the risk of local recurrence and survival after soft tissue sarcoma (STS) resection with positive margins and to evaluate the safety of sparing adjacent critical structures. METHODS: One hundred sixty-nine patients with localized STS who had positive resection margins were identified from a prospective database. Patients who had positive margins were stratified into 3 groups, each representing a specific clinical scenario: critical structure positive margin (eg major nerve, vessel, or bone), tumor bed resection positive margin, and unexpected positive margin. The rates of local recurrence-free survival (LRFS) and cause-specific survival (CSS) were calculated and compared with relevant control patients who had negative margins after STS resection. RESULTS: After planned close dissection to preserve critical structures, the 5-year LRFS and CSS rates both depended on the quality of the surgical margins (97% and 80.3%, respectively, for those with negative margins vs 85.4% and 59.4%, respectively, for those with positive margins; P = .015 and P = .05, respectively). Negative margins achieved through resection of critical structures because of tumor invasion or encasement only slightly improved the 5-year rates of LRFS (91.2%) and CSS (63.6%; P = .8 and P = .9, respectively). The lowest 5-year LRFS and CSS rates were 63.4% and 59.2%, respectively, after an unexpected positive margin during primary surgery. CONCLUSIONS: After patients undergo resection of STS with positive margins, oncologic outcomes can be predicted based on the clinical context. Sparing adjacent critical structures in this setting is safe and contributes to improved functional outcomes.

Authors
O'Donnell, PW; Griffin, AM; Eward, WC; Sternheim, A; Catton, CN; Chung, PW; O'Sullivan, B; Ferguson, PC; Wunder, JS
MLA Citation
O'Donnell, PW, Griffin, AM, Eward, WC, Sternheim, A, Catton, CN, Chung, PW, O'Sullivan, B, Ferguson, PC, and Wunder, JS. "The effect of the setting of a positive surgical margin in soft tissue sarcoma." Cancer 120.18 (September 2014): 2866-2875.
PMID
24894656
Source
epmc
Published In
Cancer
Volume
120
Issue
18
Publish Date
2014
Start Page
2866
End Page
2875
DOI
10.1002/cncr.28793

Bone Sarcomas

© 2014 John Wiley and Sons, Inc.This chapter presents a series of case studies with questions related to bone sarcomas. The first case study is about a 17-year-old Caucasian male diagnosed with Ewing sarcoma of the left humerus. Other case studies include a 52-year-old Caucasian male with 1-year history of worsening back pain despite conservative treatment, a 54-year-old Asian male diagnosed with a large chordoma of the sacrum, and a 20-year-old Caucasian male evaluated for unremitting left knee pain. Finally, the chapter discusses the case study of a 58-year-old African-American female with pain in her left leg with weight bearing.

Authors
Larrier, N; Eward, WC; Riedel, RF
MLA Citation
Larrier, N, Eward, WC, and Riedel, RF. "Bone Sarcomas." Cancer Consult: Expertise for Clinical Practice. June 20, 2014. 687-695.
Source
scopus
Publish Date
2014
Start Page
687
End Page
695
DOI
10.1002/9781118589199.ch105

A phase I study of the safety and activation of a cathepsin-activalable fluorescent cancer-specific probe LUM015.

Authors
Whitley, MJ; Cardona, DM; Blazer, DG; Hwang, SE; Mosca, PJ; Cahill, J; Ferrer, JM; Strasfeld, DB; Mlto, JK; Cuneo, KC; Lanier, N; Williams, O; Spasojevic, I; Riedel, RF; Eward, W; Lee, WD; Griffith, LG; Bawendi, M; Kirsch, DG; Brigman, BE
MLA Citation
Whitley, MJ, Cardona, DM, Blazer, DG, Hwang, SE, Mosca, PJ, Cahill, J, Ferrer, JM, Strasfeld, DB, Mlto, JK, Cuneo, KC, Lanier, N, Williams, O, Spasojevic, I, Riedel, RF, Eward, W, Lee, WD, Griffith, LG, Bawendi, M, Kirsch, DG, and Brigman, BE. "A phase I study of the safety and activation of a cathepsin-activalable fluorescent cancer-specific probe LUM015." May 20, 2014.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
32
Issue
15
Publish Date
2014

The effect of the setting of a positive surgical margin in soft tissue sarcoma

© 2014 American Cancer Society.BACKGROUND: The objectives of this study were to evaluate the risk of local recurrence and survival after soft tissue sarcoma (STS) resection with positive margins and to evaluate the safety of sparing adjacent critical structures. METHODS: One hundred sixty-nine patients with localized STS who had positive resection margins were identified from a prospective database. Patients who had positive margins were stratified into 3 groups, each representing a specific clinical scenario: critical structure positive margin (eg major nerve, vessel, or bone), tumor bed resection positive margin, and unexpected positive margin. The rates of local recurrence-free survival (LRFS) and cause-specific survival (CSS) were calculated and compared with relevant control patients who had negative margins after STS resection. RESULTS: After planned close dissection to preserve critical structures, the 5-year LRFS and CSS rates both depended on the quality of the surgical margins (97% and 80.3%, respectively, for those with negative margins vs 85.4% and 59.4%, respectively, for those with positive margins; P=.015 and P=.05, respectively). Negative margins achieved through resection of critical structures because of tumor invasion or encasement only slightly improved the 5-year rates of LRFS (91.2%) and CSS (63.6%; P=.8 and P=.9, respectively). The lowest 5-year LRFS and CSS rates were 63.4% and 59.2%, respectively, after an unexpected positive margin during primary surgery. CONCLUSIONS: After patients undergo resection of STS with positive margins, oncologic outcomes can be predicted based on the clinical context. Sparing adjacent critical structures in this setting is safe and contributes to improved functional outcomes.

Authors
O'Donnell, PW; Griffin, AM; Eward, WC; Sternheim, A; Catton, CN; Chung, PW; O'Sullivan, B; Ferguson, PC; Wunder, JS
MLA Citation
O'Donnell, PW, Griffin, AM, Eward, WC, Sternheim, A, Catton, CN, Chung, PW, O'Sullivan, B, Ferguson, PC, and Wunder, JS. "The effect of the setting of a positive surgical margin in soft tissue sarcoma." Cancer 120.18 (January 1, 2014): 2866-2875.
Source
scopus
Published In
Cancer
Volume
120
Issue
18
Publish Date
2014
Start Page
2866
End Page
2875
DOI
10.1002/cncr.28793

The vascularized fibular graft in the treatment of osteonecrosis: Data, dogma, and controversies

© Springer-Verlag Berlin Heidelberg 2014.In the debate about surgical treatment for osteonecrosis of the femoral head (ONFH), no topic is more frequently debated than the use of the free vascularized fi bular graft (FVFG) as a standard treatment. Pioneered by Urbaniak in 1979, the FVFG represents a durable, biologic means of reconstructing the femoral head after removal of the osteonecrotic bone [ 1 ]. However, this technique has been criticized for its complexity and is only widely performed at several centers throughout the world. Small numbers of cases treated operatively, diffi culty comparing uniform cases of ONFH, and the proclivity of many surgeons to utilize one particular operation preferentially have rendered direct comparison of FVFG to other techniques an unwieldy prospect [ 2 ]. What is agreed upon is that the goal of therapy should be to delay the progression of osteonecrosis as well as repair it. This chapter will focus upon how the FVFG addresses these goals, how it performs, and how it compares – indirectly at least – with other options such as core decompression, tantalum rod instrumentation, nonvascularized bone grafting, and corrective osteotomies.

Authors
Eward, W
MLA Citation
Eward, W. "The vascularized fibular graft in the treatment of osteonecrosis: Data, dogma, and controversies." Osteonecrosis. January 1, 2014. 321-323.
Source
scopus
Publish Date
2014
Start Page
321
End Page
323
DOI
10.1007/978-3-642-35767-1_44

Early follow-up of a custom non-fluted diaphyseal press-fit tumour prosthesis.

PURPOSE: The objective of this study was to evaluate the early results of a custom non-fluted diaphyseal press-fit stem for use with the global modular replacement system (GMRS) tumour prosthesis and the early complications associated with this implant. METHODS: A total of 53 patients (54 implants) were identified from a prospective database where a custom non-fluted diaphyseal press-fit stem was used as part of the reconstruction of the limb. All patients had a minimum of 22 months of follow-up. RESULTS: The rates of stem revision for any reason were calculated. The median follow-up was 36 months (range 22-85 months). Aseptic loosening was not observed in any patient. CONCLUSIONS: At early term follow-up, an uncemented non-fluted stem used with the GMRS tumour endoprosthesis provides a stable bone-prosthesis interface with no evidence of aseptic loosening.

Authors
O'Donnell, PW; Griffin, AM; Eward, WC; Sternheim, A; Wunder, JS; Ferguson, PC
MLA Citation
O'Donnell, PW, Griffin, AM, Eward, WC, Sternheim, A, Wunder, JS, and Ferguson, PC. "Early follow-up of a custom non-fluted diaphyseal press-fit tumour prosthesis." Int Orthop 38.1 (January 2014): 123-127.
PMID
24005239
Source
pubmed
Published In
International Orthopaedics
Volume
38
Issue
1
Publish Date
2014
Start Page
123
End Page
127
DOI
10.1007/s00264-013-2078-z

Extranodal Castleman disease of the extremities: a case report and review of the literature

© 2014, ISS.Castleman disease is a rare lymphoproliferative disorder of unknown etiology that most commonly presents as a mediastinal nodal mass or, in the extranodal form of the disease, a mass located in the mediastinum or retroperitoneum. It is exceptionally uncommon for Castleman disease to present in the extremities. We report a rare case of extranodal Castleman disease presenting as a muscular forearm mass. We compare our case with the seven other reported cases in which Castleman disease presented as an isolated soft tissue mass in the extremities.

Authors
Eward, WC; DeWitt, SB; Brigman, BE; Kontogeorgakos, V; Lagoo, AS
MLA Citation
Eward, WC, DeWitt, SB, Brigman, BE, Kontogeorgakos, V, and Lagoo, AS. "Extranodal Castleman disease of the extremities: a case report and review of the literature." Skeletal Radiology 43.11 (2014): 1627-1631.
Source
scival
Published In
Skeletal Radiology
Volume
43
Issue
11
Publish Date
2014
Start Page
1627
End Page
1631
DOI
10.1007/s00256-014-1945-z

The phosphaturic mesenchymal tumor: why is definitive diagnosis and curative surgery often delayed?

BACKGROUND: Tumor-induced osteomalacia is a paraneoplastic syndrome resulting in renal phosphate wasting and decreased bone mineralization. Phosphaturic mesenchymal tumors represent a rare etiology of tumor-induced osteomalacia. Nonspecific symptoms of fatigue, bone pain, and musculoskeletal weakness make the diagnosis elusive and lead to a delay in surgical treatment. QUESTIONS/PURPOSES: In this case series, the following three questions were asked: (1) How do the clinical presentation and features of phosphaturic mesenchymal tumors delay the diagnosis? (2) What is the clinical course after surgical treatment of phosphaturic mesenchymal tumors? (3) How frequently do phosphaturic mesenchymal tumors recur and are there factors associated with recurrence? METHODS: This study retrospectively reviewed the cases of five adults diagnosed and treated for phosphaturic mesenchymal tumors. Patients were identified through an internal orthopaedic oncology database with clinical, surgical, and histologic data obtained through a systematic chart review. RESULTS: Five patients presented with a long-standing history of osteomalacia, generalized fatigue, pain, and weakness before the diagnosis was reached at an average of 7.2 years (range, 2-12 years) after initial symptom onset. The diagnosis appeared to be delayed owing to the cryptic medical presentation, difficulty in locating tumor by imaging, and confirming histologic appearance. Two patients treated with wide surgical resection did not experience recurrence compared with three patients who did show recurrent signs and symptoms after marginal excision. A postoperative increase in fibroblast-derived growth factor-23 was associated with recurrent disease. CONCLUSIONS: Although uncommon, the diagnosis of phosphaturic mesenchymal tumor should be considered in any patient who presents with hypophosphaturic osteomalacia and no other physiologic cause. Definitive treatment is early, wide surgical resection.

Authors
Ledford, CK; Zelenski, NA; Cardona, DM; Brigman, BE; Eward, WC
MLA Citation
Ledford, CK, Zelenski, NA, Cardona, DM, Brigman, BE, and Eward, WC. "The phosphaturic mesenchymal tumor: why is definitive diagnosis and curative surgery often delayed?." Clin Orthop Relat Res 471.11 (November 2013): 3618-3625.
PMID
23868423
Source
pubmed
Published In
Clinical Orthopaedics and Related Research ®
Volume
471
Issue
11
Publish Date
2013
Start Page
3618
End Page
3625
DOI
10.1007/s11999-013-3178-1

NF1 deletion generates multiple subtypes of soft-tissue sarcoma that respond to MEK inhibition.

Soft-tissue sarcomas are a heterogeneous group of tumors arising from connective tissue. Recently, mutations in the neurofibromin 1 (NF1) tumor suppressor gene were identified in multiple subtypes of human soft-tissue sarcomas. To study the effect of NF1 inactivation in the initiation and progression of distinct sarcoma subtypes, we have developed a novel mouse model of temporally and spatially restricted NF1-deleted sarcoma. To generate primary sarcomas, we inject adenovirus containing Cre recombinase into NF1(flox/flox); Ink4a/Arf(flox/flox) mice at two distinct orthotopic sites: intramuscularly or in the sciatic nerve. The mice develop either high-grade myogenic sarcomas or malignant peripheral nerve sheath tumor (MPNST)-like tumors, respectively. These tumors reflect the histologic properties and spectrum of sarcomas found in patients. To explore the use of this model for preclinical studies, we conducted a study of mitogen-activated protein kinase (MAPK) pathway inhibition with the MEK inhibitor PD325901. Treatment with PD325901 delays tumor growth through decreased cyclin D1 mRNA and cell proliferation. We also examined the effects of MEK inhibition on the native tumor stroma and find that PD325901 decreases VEGFα expression in tumor cells with a corresponding decrease in microvessel density. Taken together, our results use a primary tumor model to show that sarcomas can be generated by loss of NF1 and Ink4a/Arf, and that these tumors are sensitive to MEK inhibition by direct effects on tumor cells and the surrounding microenvironment. These studies suggest that MEK inhibitors should be further explored as potential sarcoma therapies in patients with tumors containing NF1 deletion.

Authors
Dodd, RD; Mito, JK; Eward, WC; Chitalia, R; Sachdeva, M; Ma, Y; Barretina, J; Dodd, L; Kirsch, DG
MLA Citation
Dodd, RD, Mito, JK, Eward, WC, Chitalia, R, Sachdeva, M, Ma, Y, Barretina, J, Dodd, L, and Kirsch, DG. "NF1 deletion generates multiple subtypes of soft-tissue sarcoma that respond to MEK inhibition." Mol Cancer Ther 12.9 (September 2013): 1906-1917.
PMID
23858101
Source
pubmed
Published In
Molecular cancer therapeutics
Volume
12
Issue
9
Publish Date
2013
Start Page
1906
End Page
1917
DOI
10.1158/1535-7163.MCT-13-0189

Internal fixation of radiation-induced pathological fractures of the femur has a high rate of failure.

We investigated the clinical outcome of internal fixation for pathological fracture of the femur after primary excision of a soft-tissue sarcoma that had been treated with adjuvant radiotherapy. A review of our database identified 22 radiation-induced fractures of the femur in 22 patients (seven men, 15 women). We noted the mechanism of injury, fracture pattern and any complications after internal fixation, including nonunion, hardware failure, secondary fracture or deep infection. The mean age of the patients at primary excision of the tumour was 58.3 years (39 to 86). The mean time from primary excision to fracture was 73.2 months (2 to 195). The mean follow-up after fracture fixation was 65.9 months (12 to 205). Complications occurred in 19 patients (86%). Nonunion developed in 18 patients (82%), of whom 11 had a radiological nonunion at 12 months, five a nonunion and hardware failure and two an infected nonunion. One patient developed a second radiation-associated fracture of the femur after internal fixation and union of the initial fracture. A total of 13 patients (59%) underwent 24 revision operations. Internal fixation of a pathological fracture of the femur after radiotherapy for a soft-tissue sarcoma has an extremely high rate of complication and requires specialist attention.

Authors
Sternheim, A; Saidi, K; Lochab, J; O'Donnell, PW; Eward, WC; Griffin, A; Wunder, JS; Ferguson, P
MLA Citation
Sternheim, A, Saidi, K, Lochab, J, O'Donnell, PW, Eward, WC, Griffin, A, Wunder, JS, and Ferguson, P. "Internal fixation of radiation-induced pathological fractures of the femur has a high rate of failure." Bone Joint J 95-B.8 (August 2013): 1144-1148.
PMID
23908434
Source
pubmed
Published In
Bone and Joint Journal
Volume
95-B
Issue
8
Publish Date
2013
Start Page
1144
End Page
1148
DOI
10.1302/0301-620X.95B8.31832

Pancarpal synovial and tenosynovial chondromatosis in a 65-year-old man: a highly unusual presentation of a common condition.

Synovial chondromatosis is a rare, benign, metaplastic condition in which synovial tissue becomes hyperplastic, and foci of cartilaginous metaplasia develop in the synovial membranes of joints, bursae, or tendon sheaths. Involvement is most commonly monoarticular. The large joints are most commonly affected, with the knee accounting for more than half of all cases. There are isolated reports of synovial chondromatosis occurring in the small joints of the wrist and hand. However, it is very uncommon for the disease to involve multiple different synovial structures. We report the case of a middle-aged man with pancarpal synovial chondromatosis with involvement of numerous bony, articular, and tenosynovial structures within the hand and wrist.

Authors
Mata, BA; Eward, WC; Brigman, BE
MLA Citation
Mata, BA, Eward, WC, and Brigman, BE. "Pancarpal synovial and tenosynovial chondromatosis in a 65-year-old man: a highly unusual presentation of a common condition." Am J Orthop (Belle Mead NJ) 42.8 (August 2013): E60-E63. (Review)
PMID
24078960
Source
pubmed
Published In
American Journal of Orthopedics
Volume
42
Issue
8
Publish Date
2013
Start Page
E60
End Page
E63

Practical radiation oncology for extremity sarcomas.

Soft tissue sarcomas are rare cancers. They should be managed by a multidisciplinary team with experience caring for these diverse malignancies. Local control is frequently achieved with a combination of radiation therapy and surgery. This article reviews the data supporting the role of adjuvant radiotherapy in the care of patients with soft tissue sarcoma and describes the side effects of surgery and radiation therapy. Preoperative radiation therapy increases the risk of wound complication from surgery, but has fewer long-term side effects than postoperative radiation therapy. The timing of radiation therapy can be tailored to each patient.

Authors
Larrier, NA; Kirsch, DG; Riedel, RF; Levinson, H; Eward, WC; Brigman, BE
MLA Citation
Larrier, NA, Kirsch, DG, Riedel, RF, Levinson, H, Eward, WC, and Brigman, BE. "Practical radiation oncology for extremity sarcomas." Surg Oncol Clin N Am 22.3 (July 2013): 433-443. (Review)
PMID
23622072
Source
pubmed
Published In
Surgical Oncology Clinics of North America
Volume
22
Issue
3
Publish Date
2013
Start Page
433
End Page
443
DOI
10.1016/j.soc.2013.02.004

A novel imaging system permits real-time in vivo tumor bed assessment after resection of naturally occurring sarcomas in dogs.

BACKGROUND: Treatment of soft tissue sarcoma (STS) includes complete tumor excision. However, in some patients, residual sarcoma cells remain in the tumor bed. We previously described a novel hand-held imaging device prototype that uses molecular imaging to detect microscopic residual cancer in mice during surgery. QUESTIONS/PURPOSES: To test this device in a clinical trial of dogs with naturally occurring sarcomas, we asked: (1) Are any adverse clinical or laboratory effects observed after intravenous administration of the fluorescent probes? (2) Do canine sarcomas exhibit fluorescence after administration of the cathepsin-activated probe? (3) Is the tumor-to-background ratio sufficient to distinguish tumor from tumor bed? And (4) can residual fluorescence be detected in the tumor bed during surgery and does this correlate with a positive margin? METHODS: We studied nine dogs undergoing treatment for 10 STS or mast cell tumors. Dogs received an intravenous injection of VM249, a fluorescent probe that becomes optically active in the presence of cathepsin proteases. After injection, tumors were removed by wide resection. The tumor bed was imaged using the novel imaging device to search for residual fluorescence. We determined correlations between tissue fluorescence and histopathology, cathepsin protease expression, and development of recurrent disease. Minimum followup was 9 months (mean, 12 months; range, 9-15 months). RESULTS: Fluorescence was apparent from all 10 tumors and ranged from 3 × 10(7) to 1 × 10(9) counts/millisecond/cm(2). During intraoperative imaging, normal skeletal muscle showed no residual fluorescence. Histopathologic assessment of surgical margins correlated with intraoperative imaging in nine of 10 cases; in the other case, there was no residual fluorescence, but tumor was found at the margin on histologic examination. No animals had recurrent disease at 9 to 15 months. CONCLUSIONS: These initial findings suggest this imaging system might be useful to intraoperatively detect residual tumor after wide resections. CLINICAL RELEVANCE: The ability to assess the tumor bed intraoperatively for residual disease has the potential to improve local control.

Authors
Eward, WC; Mito, JK; Eward, CA; Carter, JE; Ferrer, JM; Kirsch, DG; Brigman, BE
MLA Citation
Eward, WC, Mito, JK, Eward, CA, Carter, JE, Ferrer, JM, Kirsch, DG, and Brigman, BE. "A novel imaging system permits real-time in vivo tumor bed assessment after resection of naturally occurring sarcomas in dogs." Clin Orthop Relat Res 471.3 (March 2013): 834-842.
PMID
22972654
Source
pubmed
Published In
Clinical Orthopaedics and Related Research ®
Volume
471
Issue
3
Publish Date
2013
Start Page
834
End Page
842
DOI
10.1007/s11999-012-2560-8

Training femoral neck screw insertion skills to surgical trainees: computer-assisted surgery versus conventional fluoroscopic technique.

BACKGROUND: : Femoral neck fractures are among the most common orthopaedic injuries impacting the health care system. Surgical management of such fractures with cannulated screws is a commonly performed procedure. The acquisition of surgical skills necessary to perform this procedure typically involves learning on real patients with fluoroscopic guidance. This study attempts to determine if a novel computer-navigated training model improves the learning of this basic surgical skill. METHODS: A multicenter, prospective, randomized, and controlled study was conducted using surgical trainees with no prior experience in surgically managing femoral neck fractures. After a training session, participants underwent a pretest by performing the surgical task (screw placement) on a simulated hip fracture using fluoroscopic guidance. Immediately after, participants were randomized into either undergoing a training session using conventional fluoroscopy or computer-based navigation. Immediate posttest, retention (4 weeks later), and transfer tests were performed. Performance during the tests was determined by radiographic analysis of hardware placement. RESULTS: Screw placement by trainees was ultimately equal to the level of an expert surgeon with either training technique. Participants who trained with computer navigation took fewer attempts to position hardware and used less fluoroscopy time than those trained with fluoroscopy. When those trained with fluoroscopy used computer navigation at the transfer test, less fluoroscopy time and dosage was used. The concurrent augmented feedback provided by computer navigation did not affect the learning of this basic surgical skill in surgical novices. No compromise in learning occurred if the surgical novice trained with one type of technology and transferred to using the other. CONCLUSIONS: The findings of this study suggest that computer navigation may be safely used to train surgical novices in a basic procedure. This model avoids using both live patients and harmful radiation without a compromise in the acquisition of a 3-dimensional technical skill.

Authors
Nousiainen, MT; Omoto, DM; Zingg, PO; Weil, YA; Mardam-Bey, SW; Eward, WC
MLA Citation
Nousiainen, MT, Omoto, DM, Zingg, PO, Weil, YA, Mardam-Bey, SW, and Eward, WC. "Training femoral neck screw insertion skills to surgical trainees: computer-assisted surgery versus conventional fluoroscopic technique." J Orthop Trauma 27.2 (February 2013): 87-92.
PMID
22688433
Source
pubmed
Published In
Journal of Orthopaedic Trauma
Volume
27
Issue
2
Publish Date
2013
Start Page
87
End Page
92
DOI
10.1097/BOT.0b013e3182604b49

The phosphaturic mesenchymal tumor: Why is definitive diagnosis and curative surgery often delayed?

Background: Tumor-induced osteomalacia is a paraneoplastic syndrome resulting in renal phosphate wasting and decreased bone mineralization. Phosphaturic mesenchymal tumors represent a rare etiology of tumor-induced osteomalacia. Nonspecific symptoms of fatigue, bone pain, and musculoskeletal weakness make the diagnosis elusive and lead to a delay in surgical treatment. Questions/purposes: In this case series, the following three questions were asked: (1) How do the clinical presentation and features of phosphaturic mesenchymal tumors delay the diagnosis? (2) What is the clinical course after surgical treatment of phosphaturic mesenchymal tumors? (3) How frequently do phosphaturic mesenchymal tumors recur and are there factors associated with recurrence? Methods: This study retrospectively reviewed the cases of five adults diagnosed and treated for phosphaturic mesenchymal tumors. Patients were identified through an internal orthopaedic oncology database with clinical, surgical, and histologic data obtained through a systematic chart review. Results: Five patients presented with a long-standing history of osteomalacia, generalized fatigue, pain, and weakness before the diagnosis was reached at an average of 7.2 years (range, 2-12 years) after initial symptom onset. The diagnosis appeared to be delayed owing to the cryptic medical presentation, difficulty in locating tumor by imaging, and confirming histologic appearance. Two patients treated with wide surgical resection did not experience recurrence compared with three patients who did show recurrent signs and symptoms after marginal excision. A postoperative increase in fibroblast-derived growth factor-23 was associated with recurrent disease. Conclusions: Although uncommon, the diagnosis of phosphaturic mesenchymal tumor should be considered in any patient who presents with hypophosphaturic osteomalacia and no other physiologic cause. Definitive treatment is early, wide surgical resection. Level of Evidence: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence. © 2013 The Association of Bone and Joint Surgeons®.

Authors
Ledford, CK; Zelenski, NA; Cardona, DM; Brigman, BE; Eward, WC
MLA Citation
Ledford, CK, Zelenski, NA, Cardona, DM, Brigman, BE, and Eward, WC. "The phosphaturic mesenchymal tumor: Why is definitive diagnosis and curative surgery often delayed?." Clinical Orthopaedics and Related Research 471.11 (2013): 3618-3625.
Source
scival
Published In
Clinical Orthopaedics and Related Research ®
Volume
471
Issue
11
Publish Date
2013
Start Page
3618
End Page
3625
DOI
10.1007/s11999-013-3178-1

Can Experienced Observers Differentiate between Lipoma and Well-Differentiated Liposarcoma Using Only MRI?

Well-differentiated liposarcoma represents a radiographic diagnostic dilemma. To determine the accuracy, interrater reliability, and relationship of stranding, nodularity, and size in the MRI differentiation of lipoma and well-differentiated liposarcoma, MRI scans of 60 patients with large (>5 cm), deep, pathologically proven lipomas or well-differentiated liposarcomas were examined by 10 observers with subspecialty training blinded to diagnosis. Observers indicated whether the amount of stranding, nodularity, and size of each tumor suggested a benign or malignant diagnosis and rendered a diagnosis of lipoma or well-differentiated liposarcoma. The accuracy, reliability, and relationship of stranding, nodularity, and size to diagnosis were calculated for all samples. 69% of reader MRI diagnoses agreed with final pathology diagnosis (95% CI 65-73%). Readers tended to err choosing a diagnosis of liposarcoma, correctly identifying lipomas in 63% of cases (95% CI 58-69%) and liposarcomas in 75% of cases (95% CI 69-80%). Assessment of the relationship of stranding, nodularity, and size to correct diagnosis showed that the presence of each was associated with a decreased likelihood of a lipoma pathological diagnosis (P < 0.01). While the radiographic diagnosis of lipoma or well-differentiated liposarcoma cannot be made with 100% certainty, experienced observers have a 69% chance of rendering a correct diagnosis.

Authors
O'Donnell, PW; Griffin, AM; Eward, WC; Sternheim, A; White, LM; Wunder, JS; Ferguson, PC
MLA Citation
O'Donnell, PW, Griffin, AM, Eward, WC, Sternheim, A, White, LM, Wunder, JS, and Ferguson, PC. "Can Experienced Observers Differentiate between Lipoma and Well-Differentiated Liposarcoma Using Only MRI?." Sarcoma 2013 (2013): 982784-.
PMID
24385845
Source
pubmed
Published In
Sarcoma
Volume
2013
Publish Date
2013
Start Page
982784
DOI
10.1155/2013/982784

Training femoral neck screw insertion skills to surgical trainees: Computer-assisted surgery versus conventional fluoroscopic technique

BACKGROUND: Femoral neck fractures are among the most common orthopaedic injuries impacting the health care system. Surgical management of such fractures with cannulated screws is a commonly performed procedure. The acquisition of surgical skills necessary to perform this procedure typically involves learning on real patients with fluoroscopic guidance. This study attempts to determine if a novel computer-navigated training model improves the learning of this basic surgical skill. METHODS: A multicenter, prospective, randomized, and controlled study was conducted using surgical trainees with no prior experience in surgically managing femoral neck fractures. After a training session, participants underwent a pretest by performing the surgical task (screw placement) on a simulated hip fracture using fluoroscopic guidance. Immediately after, participants were randomized into either undergoing a training session using conventional fluoroscopy or computer-based navigation. Immediate posttest, retention (4 weeks later), and transfer tests were performed. Performance during the tests was determined by radiographic analysis of hardware placement. RESULTS: Screw placement by trainees was ultimately equal to the level of an expert surgeon with either training technique. Participants who trained with computer navigation took fewer attempts to position hardware and used less fluoroscopy time than those trained with fluoroscopy. When those trained with fluoroscopy used computer navigation at the transfer test, less fluoroscopy time and dosage was used. The concurrent augmented feedback provided by computer navigation did not affect the learning of this basic surgical skill in surgical novices. No compromise in learning occurred if the surgical novice trained with one type of technology and transferred to using the other. CONCLUSIONS: The findings of this study suggest that computer navigation may be safely used to train surgical novices in a basic procedure. This model avoids using both live patients and harmful radiation without a compromise in the acquisition of a 3-dimensional technical skill. Copyright © 2013 by Lippincott Williams &Wilkins.

Authors
Nousiainen, MT; Omoto, DM; Zingg, PO; Weil, YA; Mardam-Bey, SW; Eward, WC
MLA Citation
Nousiainen, MT, Omoto, DM, Zingg, PO, Weil, YA, Mardam-Bey, SW, and Eward, WC. "Training femoral neck screw insertion skills to surgical trainees: Computer-assisted surgery versus conventional fluoroscopic technique." Journal of Orthopaedic Trauma 27.2 (2013): 87-92.
Source
scival
Published In
Journal of Orthopaedic Trauma
Volume
27
Issue
2
Publish Date
2013
Start Page
87
End Page
92
DOI
10.1097/BOT.0b013e3182604b49

A novel imaging system permits real-time in vivo tumor bed assessment after resection of naturally occurring sarcomas in dogs tumor

Background: Treatment of soft tissue sarcoma (STS) includes complete tumor excision. However, in some patients, residual sarcoma cells remain in the tumor bed. We previously described a novel hand-held imaging device prototype that uses molecular imaging to detect microscopic residual cancer in mice during surgery. Questions/purposes: To test this device in a clinical trial of dogs with naturally occurring sarcomas, we asked: (1) Are any adverse clinical or laboratory effects observed after intravenous administration of the fluorescent probes? (2) Do canine sarcomas exhibit fluorescence after administration of the cathepsin-activated probe? (3) Is the tumor-to-background ratio sufficient to distinguish tumor from tumor bed? And (4) can residual fluorescence be detected in the tumor bed during surgery and does this correlate with a positive margin? Methods: We studied nine dogs undergoing treatment for 10 STS or mast cell tumors. Dogs received an intravenous injection of VM249, a fluorescent probe that becomes optically active in the presence of cathepsin proteases. After injection, tumors were removed by wide resection. The tumor bed was imaged using the novel imaging device to search for residual fluorescence. We determined correlations between tissue fluorescence and histopathology, cathepsin protease expression, and development of recurrent disease. Minimum followup was 9 months (mean, 12 months; range, 9-15 months). Results: Fluorescence was apparent from all 10 tumors and ranged from 3 × 107 to 1 × 10 9 counts/millisecond/cm2. During intraoperative imaging, normal skeletal muscle showed no residual fluorescence. Histopathologic assessment of surgical margins correlated with intraoperative imaging in nine of 10 cases; in the other case, there was no residual fluorescence, but tumor was found at the margin on histologic examination. No animals had recurrent disease at 9 to 15 months. Conclusions: These initial findings suggest this imaging system might be useful to intraoperatively detect residual tumor after wide resections. Clinical Relevance: The ability to assess the tumor bed intraoperatively for residual disease has the potential to improve local control. © 2012 The Association of Bone and Joint Surgeons®.

Authors
Eward, WC; Mito, JK; Eward, CA; Carter, JE; Ferrer, JM; Kirsch, DG; Brigman, BE
MLA Citation
Eward, WC, Mito, JK, Eward, CA, Carter, JE, Ferrer, JM, Kirsch, DG, and Brigman, BE. "A novel imaging system permits real-time in vivo tumor bed assessment after resection of naturally occurring sarcomas in dogs tumor." Clinical Orthopaedics and Related Research 471.3 (2013): 834-842.
Source
scival
Published In
Clinical Orthopaedics and Related Research ®
Volume
471
Issue
3
Publish Date
2013
Start Page
834
End Page
842
DOI
10.1007/s11999-012-2560-8

Internal fixation of radiation-induced pathological fractures of the femur has a high rate of failure

We investigated the clinical outcome of internal fixation for pathological fracture of the femur after primary excision of a soft-tissue sarcoma that had been treated with adjuvant radiotherapy. A review of our database identified 22 radiation-induced fractures of the femur in 22 patients (seven men, 15 women). We noted the mechanism of injury, fracture pattern and any complications after internal fixation, including nonunion, hardware failure, secondary fracture or deep infection. The mean age of the patients at primary excision of the tumour was 58.3 years (39 to 86). The mean time from primary excision to fracture was 73.2 months (2 to 195). The mean follow-up after fracture fixation was 65.9 months (12 to 205). Complications occurred in 19 patients (86%). Nonunion developed in 18 patients (82%), of whom 11 had a radiological nonunion at 12 months, five a nonunion and hardware failure and two an infected nonunion. One patient developed a second radiation-associated fracture of the femur after internal fixation and union of the initial fracture. A total of 13 patients (59%) underwent 24 revision operations. Internal fixation of a pathological fracture of the femur after radiotherapy for a soft-tissue sarcoma has an extremely high rate of complication and requires specialist attention. © 2013 The British Editorial Society of Bone & Joint Surgery.

Authors
Sternheim, A; Saidi, K; Lochab, J; O'Donnell, PW; Eward, WC; Griffin, A; Wunder, JS; Ferguson, P
MLA Citation
Sternheim, A, Saidi, K, Lochab, J, O'Donnell, PW, Eward, WC, Griffin, A, Wunder, JS, and Ferguson, P. "Internal fixation of radiation-induced pathological fractures of the femur has a high rate of failure." Bone and Joint Journal 95 B.8 (2013): 1144-1148.
Source
scival
Published In
Bone and Joint Journal
Volume
95 B
Issue
8
Publish Date
2013
Start Page
1144
End Page
1148
DOI
10.1302/0301-620X.95B8

The vascularized fibular graft in the pediatric upper extremity: a durable, biological solution to large oncologic defects.

Skeletal reconstruction after large tumor resection is challenging. The free vascularized fibular graft (FVFG) offers the potential for rapid autograft incorporation as well as growing physeal transfer in pediatric patients. We retrospectively reviewed eleven pediatric patients treated with FVFG reconstructions of the upper extremity after tumor resection. Eight male and three female patients were identified, including four who underwent epiphyseal transfer. All eleven patients retained a functional salvaged limb. Nonunion and graft fracture were the most common complications relating to graft site (27%). Peroneal nerve palsy occurred in 4/11 patients, all of whom received epiphyseal transfer. Patients receiving epiphyseal transplant had a mean annual growth of 1.7 cm/year. Mean graft hypertrophy index increased by more than 10% in all cases. Although a high complication rate may be anticipated, the free vascularized fibula may be used to reconstruct large skeletal defects in the pediatric upper extremity after oncologic resection. Transferring the vascularized physis is a viable option when longitudinal growth is desired.

Authors
Zelenski, N; Brigman, BE; Levin, LS; Erdmann, D; Eward, WC
MLA Citation
Zelenski, N, Brigman, BE, Levin, LS, Erdmann, D, and Eward, WC. "The vascularized fibular graft in the pediatric upper extremity: a durable, biological solution to large oncologic defects." Sarcoma 2013 (2013): 321201-.
PMID
24222724
Source
pubmed
Published In
Sarcoma
Volume
2013
Publish Date
2013
Start Page
321201
DOI
10.1155/2013/321201

Intraoperative detection and removal of microscopic residual sarcoma using wide-field imaging.

BACKGROUND: The goal of limb-sparing surgery for a soft tissue sarcoma of the extremity is to remove all malignant cells while preserving limb function. After initial surgery, microscopic residual disease in the tumor bed will cause a local recurrence in approximately 33% of patients with sarcoma. To help identify these patients, the authors developed an in vivo imaging system to investigate the suitability of molecular imaging for intraoperative visualization. METHODS: A primary mouse model of soft tissue sarcoma and a wide field-of-view imaging device were used to investigate a series of exogenously administered, near-infrared (NIR) fluorescent probes activated by cathepsin proteases for real-time intraoperative imaging. RESULTS: The authors demonstrated that exogenously administered cathepsin-activated probes can be used for image-guided surgery to identify microscopic residual NIR fluorescence in the tumor beds of mice. The presence of residual NIR fluorescence was correlated with microscopic residual sarcoma and local recurrence. The removal of residual NIR fluorescence improved local control. CONCLUSIONS: The authors concluded that their technique has the potential to be used for intraoperative image-guided surgery to identify microscopic residual disease in patients with cancer.

Authors
Mito, JK; Ferrer, JM; Brigman, BE; Lee, C-L; Dodd, RD; Eward, WC; Marshall, LF; Cuneo, KC; Carter, JE; Ramasunder, S; Kim, Y; Lee, WD; Griffith, LG; Bawendi, MG; Kirsch, DG
MLA Citation
Mito, JK, Ferrer, JM, Brigman, BE, Lee, C-L, Dodd, RD, Eward, WC, Marshall, LF, Cuneo, KC, Carter, JE, Ramasunder, S, Kim, Y, Lee, WD, Griffith, LG, Bawendi, MG, and Kirsch, DG. "Intraoperative detection and removal of microscopic residual sarcoma using wide-field imaging." Cancer 118.21 (November 1, 2012): 5320-5330.
PMID
22437667
Source
pubmed
Published In
Cancer
Volume
118
Issue
21
Publish Date
2012
Start Page
5320
End Page
5330
DOI
10.1002/cncr.27458

The vascularized fibular graft in precollapse osteonecrosis: is long-term hip preservation possible?

BACKGROUND: Osteonecrosis of the femoral head (ONFH) is a debilitating condition affecting primarily young patients. Free vascularized fibular grafting (FVFG) may provide a durable means to preserve the femoral head. When used in the precollapse stages of ONFH, this treatment may alter the course of disease. QUESTIONS/PURPOSES: We asked: (1) In what percentage of patients does FVFG preserve the femoral head beyond 10 years? (2) When long-term preservation is not achieved, what is the duration of femoral head preservation? (3) Do demographic or etiologic factors predict FVFG survivorship? (4) What long-term improvements in function and activity can be anticipated? METHODS: We retrospectively reviewed 61 patients (65 hips) who underwent FVFG for precollapse ONFH. We calculated graft survivorship, SF-12 scores, activity levels, and Harris hip scores. Minimum followup was 10.5 years (mean, 14.4 years; range, 10.5-26 years). Results Forty-nine of 65 hips (75%) had surviving FVFG for at least 10 years. At last followup, 39 of 65 hips (60%) had surviving FVFG, with a mean graft survival time of 15 years (range, 10.5-26.1 years). Twenty-six of the 65 hips with FVFG (40%) underwent conversion to THA at a mean of 8 years postoperatively. Demographic factors, lesion size, additional procedures, and low preoperative function were not associated with changes in graft survivorship. Pain and function were similar in patients with surviving FVFG and patients who had conversion to THA. Patients with surviving FVFG were more likely to engage in impact sports or active events than were patients who had conversion to THA. CONCLUSIONS: When patients with precollapse ONFH undergo FVFG, the majority have preservation of the hip lasting for greater than 10 years with low levels of pain and reasonable function. In patients who ultimately undergo conversion surgery to THA, the mean duration of hip preservation before conversion is 8 years. We continue to use FVFG for treating patients younger than 50 years with symptomatic, precollapse ONFH. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Instructions to Authors for a complete description of levels of evidence.

Authors
Eward, WC; Rineer, CA; Urbaniak, JR; Richard, MJ; Ruch, DS
MLA Citation
Eward, WC, Rineer, CA, Urbaniak, JR, Richard, MJ, and Ruch, DS. "The vascularized fibular graft in precollapse osteonecrosis: is long-term hip preservation possible?." Clin Orthop Relat Res 470.10 (October 2012): 2819-2826.
PMID
22733182
Source
pubmed
Published In
Clinical Orthopaedics and Related Research ®
Volume
470
Issue
10
Publish Date
2012
Start Page
2819
End Page
2826
DOI
10.1007/s11999-012-2429-x

Surgical treatment and prognosis in patients with high-grade soft tissue malignant fibrous histiocytoma of the extremities.

BACKGROUND: Malignant fibrous histiocytoma (MFH) of soft tissue is one of the most common sarcoma in adulthood. However, only a few series have separately studied the clinical behavior and prognosis of this malignancy. METHODS: We retrospectively reviewed 61 patients treated for extremity soft tissue high-grade MFH. Four patients had a history of another malignancy and were excluded from analysis. In 12 referred patients with incomplete excision, re-excision of the tumor bed was offered. Clinical and treatment variables were analyzed for their impact on treatment complications, local recurrence (LR), metastatic disease (MD) and overall survival (OS). RESULTS: Four patients underwent primary amputation. Twenty-three patients necessitated a primary reconstructive procedure for wound closure. Wound healing complication (WHC) developed in 28.3 % of the limb sparing group of patients. LR developed in 11 patients (19.3 %), while 6 of them had second LR. Eighteen patients (31.5 %) developed MD, involving lung at least. Patients who developed MD <12  vs >12 months, died within 19.3 vs 8 months mean time (p < 0.05). Overall survivorship was 66.7 % at 5 years. No statistically significant variables were identified for LR, while multivariate analysis for MD revealed tumor size >5 cm as the only statistically significant variable. For OS, development of MD and age >70 years emerged as independent prognostic factors. CONCLUSIONS: The overall prognosis is poor. LR, although can be managed with tumor re-excision, has high second recurrence rate. Increased tumor size is associated with shorter metastasis-free interval which significantly decreases survival.

Authors
Vasileios, KA; Eward, WC; Brigman, BE
MLA Citation
Vasileios, KA, Eward, WC, and Brigman, BE. "Surgical treatment and prognosis in patients with high-grade soft tissue malignant fibrous histiocytoma of the extremities." Arch Orthop Trauma Surg 132.7 (July 2012): 955-961.
PMID
22487849
Source
pubmed
Published In
Archives of Orthopaedic and Trauma Surgery
Volume
132
Issue
7
Publish Date
2012
Start Page
955
End Page
961
DOI
10.1007/s00402-012-1510-y

Surgical treatment and prognosis in patients with high-grade soft tissue malignant fibrous histiocytoma of the extremities

Background: Malignant fibrous histiocytoma (MFH) of soft tissue is one of the most common sarcoma in adulthood. However, only a few series have separately studied the clinical behavior and prognosis of this malignancy. Methods: We retrospectively reviewed 61 patients treated for extremity soft tissue high-grade MFH. Four patients had a history of another malignancy and were excluded from analysis. In 12 referred patients with incomplete excision, re-excision of the tumor bed was offered. Clinical and treatment variables were analyzed for their impact on treatment complications, local recurrence (LR), metastatic disease (MD) and overall survival (OS). Results: Four patients underwent primary amputation. Twenty-three patients necessitated a primary reconstructive procedure for wound closure. Wound healing complication (WHC) developed in 28.3 % of the limb sparing group of patients. LR developed in 11 patients (19.3 %), while 6 of them had second LR. Eighteen patients (31.5 %) developed MD, involving lung at least. Patients who developed MD <12  vs >12 months, died within 19.3 vs 8 months mean time (p < 0.05). Overall survivorship was 66.7 % at 5 years. No statistically significant variables were identified for LR, while multivariate analysis for MD revealed tumor size >5 cm as the only statistically significant variable. For OS, development of MD and age >70 years emerged as independent prognostic factors. Conclusions: The overall prognosis is poor. LR, although can be managed with tumor re-excision, has high second recurrence rate. Increased tumor size is associated with shorter metastasis-free interval which significantly decreases survival. © 2012 Springer-Verlag.

Authors
Vasileios, KA; Eward, WC; Brigman, BE
MLA Citation
Vasileios, KA, Eward, WC, and Brigman, BE. "Surgical treatment and prognosis in patients with high-grade soft tissue malignant fibrous histiocytoma of the extremities." Archives of Orthopaedic and Trauma Surgery (2012): 1-7.
Source
scival
Published In
Archives of Orthopaedic and Trauma Surgery
Publish Date
2012
Start Page
1
End Page
7
DOI
10.1007/s00402-012-1510-y

[Femur reconstruction using combined autologous fibula transfer and humeral allograft].

Wide resection far into the femoral metaphysis may be required to treat malignant bone tumors in the pediatric and adolescent patient population. Biological reconstruction using a free, vascularized fibular graft is a well-established surgical technique. A short remaining femoral medullary canal and a relatively small fibula diameter can make fixation of the vascularized bone transfer difficult. Stable fixation and short fusion times, however, can be achieved with the use of an additional humeral allograft and plate osteosynthesis.

Authors
Kokosis, G; Stolberg-Stolberg, J; Eward, WC; Richard, MJ; Hollenbeck, ST; Levinson, H; Brigman, BE; Erdmann, D
MLA Citation
Kokosis, G, Stolberg-Stolberg, J, Eward, WC, Richard, MJ, Hollenbeck, ST, Levinson, H, Brigman, BE, and Erdmann, D. "[Femur reconstruction using combined autologous fibula transfer and humeral allograft]." Chirurg 82.12 (December 2011): 1120-1123.
PMID
21901467
Source
pubmed
Published In
Der Chirurg
Volume
82
Issue
12
Publish Date
2011
Start Page
1120
End Page
1123
DOI
10.1007/s00104-011-2165-x

Dissecting molecular mechanisms of metastasis in a primary mouse model of soft tissue sarcoma

Authors
Mito, JK; Dodd, RD; Brigman, BE; Li, Z; Eward, WC; Mukherjee, S; Kirsch, D
MLA Citation
Mito, JK, Dodd, RD, Brigman, BE, Li, Z, Eward, WC, Mukherjee, S, and Kirsch, D. "Dissecting molecular mechanisms of metastasis in a primary mouse model of soft tissue sarcoma." CLINICAL & EXPERIMENTAL METASTASIS 28.2 (February 2011): 166-167.
Source
wos-lite
Published In
Clinical & Experimental Metastasis
Volume
28
Issue
2
Publish Date
2011
Start Page
166
End Page
167

Dissecting mechanisms of metastasis using a mouse model of cancer

Authors
Dodd, RD; Mito, J; Brigman, B; Eward, W; Dodd, L; Mukherjee, S; Krisch, D
MLA Citation
Dodd, RD, Mito, J, Brigman, B, Eward, W, Dodd, L, Mukherjee, S, and Krisch, D. "Dissecting mechanisms of metastasis using a mouse model of cancer." CLINICAL & EXPERIMENTAL METASTASIS 28.2 (February 2011): 166-166.
Source
wos-lite
Published In
Clinical & Experimental Metastasis
Volume
28
Issue
2
Publish Date
2011
Start Page
166
End Page
166

Case report: lead toxicity associated with an extra-articular retained missile 14 years after injury.

Lead toxicity associated with extra-articular retained missiles (EARMs) is an uncommon yet potentially devastating complication of gunshot wounds. While the risk of lead toxicity with intra-articular retained missiles is well-known, EARMs are routinely permitted to remain in tissues indefinitely without surveillance for lead toxicity. We present a 34 year-old man who was found to have symptomatic lead toxicity 14 years after sustaining a gunshot-associated femoral fracture with retention of lead bullet fragments. A fluid-filled cyst containing two large lead bullet fragments was identified intraoperatively. Whole-blood lead concentration decreased after removal of the lead-filled cyst. Cyst formation and concomitant bone fracture are two of the risk factors for lead toxicity in patients with EARMs after gunshot wounds. Recognizing risk factors for EARM-associated elevation in lead levels is important as the adverse effects of increased lead burden may be asymptomatic and difficult to diagnose, yet debilitating and potentially lethal.

Authors
Eward, WC; Darcey, D; Dodd, LG; Zura, RD
MLA Citation
Eward, WC, Darcey, D, Dodd, LG, and Zura, RD. "Case report: lead toxicity associated with an extra-articular retained missile 14 years after injury." J Surg Orthop Adv 20.4 (2011): 241-246.
PMID
22381417
Source
pubmed
Published In
Journal of surgical orthopaedic advances
Volume
20
Issue
4
Publish Date
2011
Start Page
241
End Page
246

Effects of Radiation Therapy on the Detection of Microscopic Residual Cancer in the Surgical Bed using a Protease-activated Fluorescent Probe in a Primary Soft Tissue Sarcoma Model

Authors
Cuneo, KC; Mito, JK; Brigman, BE; Ferrer, JM; Lee, C; Eward, WC; Carter, JE; Kirsch, DG
MLA Citation
Cuneo, KC, Mito, JK, Brigman, BE, Ferrer, JM, Lee, C, Eward, WC, Carter, JE, and Kirsch, DG. "Effects of Radiation Therapy on the Detection of Microscopic Residual Cancer in the Surgical Bed using a Protease-activated Fluorescent Probe in a Primary Soft Tissue Sarcoma Model." INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS 81.2 (2011): S729-S730.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
81
Issue
2
Publish Date
2011
Start Page
S729
End Page
S730

Pseudotumor with superimposed periprosthetic infection following metal-on-metal total hip arthroplasty: a case report.

Authors
Watters, TS; Eward, WC; Hallows, RK; Dodd, LG; Wellman, SS; Bolognesi, MP
MLA Citation
Watters, TS, Eward, WC, Hallows, RK, Dodd, LG, Wellman, SS, and Bolognesi, MP. "Pseudotumor with superimposed periprosthetic infection following metal-on-metal total hip arthroplasty: a case report." J Bone Joint Surg Am 92.7 (July 7, 2010): 1666-1669.
Website
http://hdl.handle.net/10161/4610
PMID
20595575
Source
pubmed
Published In
The Journal of Bone and Joint Surgery
Volume
92
Issue
7
Publish Date
2010
Start Page
1666
End Page
1669
DOI
10.2106/JBJS.I.01208

Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection.

UNLABELLED: Skeletal reconstruction of large tumor resection defects is challenging. Free vascularized fibular transfer offers the potential for rapid autograft incorporation in limbs compromised by adjuvant chemotherapy or radiation. We retrospectively reviewed 30 patients treated with free vascularized fibular graft reconstruction of large skeletal defects after tumor resections (mean defect length, 14.8 cm). The minimum followup was 2 years (mean, 4.9 years; range, 2-15 years). One patient died with liver and lung metastases at 3 years postoperatively. Loss of limb occurred in one patient. Five patients either had metastatic disease (one patient) or had metastatic disease (four patients) develop after treatment, with a mean time to metastasis of 18 months. The overall complication rate was 16 of 30 (53%), with a reoperation rate of 12 of 30 (40%). Union was attained in all 30 grafts. Primary union was attained in 23 (77%) at a mean of 6 months. Secondary union was achieved in seven (23%) after revision fixation and bone grafting; the mean subsequent time to union was 9.2 months, with an index of 1.33 additional operations per patient. Graft fracture (20%) and infection (10%) were other common complications. Despite a high complication rate, free vascularized fibular graft reconstruction offers a reliable treatment of large skeletal defects after tumor resection without increased risk of limb loss, local recurrence, or tumor metastasis. LEVEL OF EVIDENCE: Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

Authors
Eward, WC; Kontogeorgakos, V; Levin, LS; Brigman, BE
MLA Citation
Eward, WC, Kontogeorgakos, V, Levin, LS, and Brigman, BE. "Free vascularized fibular graft reconstruction of large skeletal defects after tumor resection." Clin Orthop Relat Res 468.2 (February 2010): 590-598.
PMID
19701672
Source
pubmed
Published In
Clinical Orthopaedics and Related Research ®
Volume
468
Issue
2
Publish Date
2010
Start Page
590
End Page
598
DOI
10.1007/s11999-009-1053-x

Cross species genomic analysis identifies a mouse model as undifferentiated pleomorphic sarcoma/malignant fibrous histiocytoma.

Undifferentiated pleomorphic sarcoma/Malignant Fibrous Histiocytoma (MFH) is one of the most common subtypes of human soft tissue sarcoma. Using cross species genomic analysis, we define a geneset from the LSL-Kras(G12D); Trp53(Flox/Flox) mouse model of soft tissue sarcoma that is highly enriched in human MFH. With this mouse geneset as a filter, we identify expression of the RAS target FOXM1 in human MFH. Expression of Foxm1 is elevated in mouse sarcomas that metastasize to the lung and tissue microarray analysis of human MFH correlates overexpression of FOXM1 with metastasis. These results suggest that genomic alterations present in human MFH are conserved in the LSL-Kras(G12D); p53(Flox/Flox) mouse model of soft tissue sarcoma and demonstrate the utility of this pre-clinical model.

Authors
Mito, JK; Riedel, RF; Dodd, L; Lahat, G; Lazar, AJ; Dodd, RD; Stangenberg, L; Eward, WC; Hornicek, FJ; Yoon, SS; Brigman, BE; Jacks, T; Lev, D; Mukherjee, S; Kirsch, DG
MLA Citation
Mito, JK, Riedel, RF, Dodd, L, Lahat, G, Lazar, AJ, Dodd, RD, Stangenberg, L, Eward, WC, Hornicek, FJ, Yoon, SS, Brigman, BE, Jacks, T, Lev, D, Mukherjee, S, and Kirsch, DG. "Cross species genomic analysis identifies a mouse model as undifferentiated pleomorphic sarcoma/malignant fibrous histiocytoma. (Published online)" PLoS One 4.11 (November 30, 2009): e8075-.
PMID
19956606
Source
pubmed
Published In
PloS one
Volume
4
Issue
11
Publish Date
2009
Start Page
e8075
DOI
10.1371/journal.pone.0008075

Attitudes toward physician-assisted suicide among physicians in Vermont

Background: Legislation on physician-assisted suicide (PAS) is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have: historically assessed particular subsets of physicians. Objective: To determine variables predictive of physicians' opinions on PAS in a rural state, Vermont, USA. Design: Cross-sectional mailing survey. Participants: 1052 (48% response rate) physicians licensed by the state of Vermont. Results: Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation (42% vs 34%). Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness (48% vs 33%). 30% of the respondents had experienced a request for assistance with suicide. Conclusions: Vermont physicians' opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor-patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management.

Authors
Craig, A; Cronin, B; Eward, W; Metz, J; Murray, L; Rose, G; Suess, E; Vergara, ME
MLA Citation
Craig, A, Cronin, B, Eward, W, Metz, J, Murray, L, Rose, G, Suess, E, and Vergara, ME. "Attitudes toward physician-assisted suicide among physicians in Vermont." Journal of Medical Ethics 33.7 (2007): 400-403.
PMID
17601867
Source
scival
Published In
Journal of medical ethics
Volume
33
Issue
7
Publish Date
2007
Start Page
400
End Page
403
DOI
10.1136/jme.2006.018713

LANSOPRAZOLE ATTENUATES NEUTROPHIL-MEDIATED TISSUE DAMAGE OF LIVER FOLLOWING VISCERAL ISCHEMIA-REPERFUSION INJURY IN MICE.

Authors
Rebuck, JA; Eward, W; Slusarczyk, M; Suratt, B; Hebert, J; Petty, J
MLA Citation
Rebuck, JA, Eward, W, Slusarczyk, M, Suratt, B, Hebert, J, and Petty, J. "LANSOPRAZOLE ATTENUATES NEUTROPHIL-MEDIATED TISSUE DAMAGE OF LIVER FOLLOWING VISCERAL ISCHEMIA-REPERFUSION INJURY IN MICE." December 2006.
Source
crossref
Published In
Critical Care Medicine
Volume
34
Publish Date
2006
Start Page
A147
End Page
A147
DOI
10.1097/00003246-200612002-00510

Immunohistochemistry of the canine vomeronasal organ.

The canine's olfactory acuity is legendary, but neither its main olfactory system nor its vomeronasal system has been described in much detail. We used immunohistochemistry on paraffin-embedded sections of male and female adult dog vomeronasal organ (VNO) to characterize the expression of proteins known to be expressed in the VNO of several other mammals. Basal cell bodies were more apparent in each section than in rodent VNO and expressed immunoreactivity to anticytokeratin and antiepidermal growth factor receptor antibodies. The thin layer of neurone cell bodies in the sensory epithelium and axon fascicles in the lamina propria expressed immunoreactivity to neurone cell adhesion molecule, neurone-specific beta tubulin and protein gene product 9.5. Some neurones expressed growth-associated protein 43 (GAP43): and a number of those also expressed neurone-specific beta tubulin-immunoreactivity. Some axon fascicles were double labelled for those two proteins. The G-protein alpha subunits Gi and Go, involved in the signal transduction pathway, showed immunoreactivity in the sensory cell layer. Our results demonstrate that the canine vomeronasal organ contains a population of cells that expresses several neuronal markers. Furthermore, GAP43 immunoreactivity suggests that the sensory epithelium is neurogenic in adult dogs.

Authors
Dennis, JC; Allgier, JG; Desouza, LS; Eward, WC; Morrison, EE
MLA Citation
Dennis, JC, Allgier, JG, Desouza, LS, Eward, WC, and Morrison, EE. "Immunohistochemistry of the canine vomeronasal organ." J Anat 203.3 (September 2003): 329-338.
PMID
14529050
Source
pubmed
Published In
Journal of Anatomy
Volume
203
Issue
3
Publish Date
2003
Start Page
329
End Page
338

Immunohistochemistry of the canine vomeronasal organ (vol 202, pg 329, 2003)

Authors
Dennis, JC; Allgier, JG; Desouza, LS; Eward, WC; Morrison, EE
MLA Citation
Dennis, JC, Allgier, JG, Desouza, LS, Eward, WC, and Morrison, EE. "Immunohistochemistry of the canine vomeronasal organ (vol 202, pg 329, 2003)." JOURNAL OF ANATOMY 203.3 (September 2003): 345-345.
Source
wos-lite
Published In
Journal of Anatomy
Volume
203
Issue
3
Publish Date
2003
Start Page
345
End Page
345

Shuttle mission effects on glutamate receptor expression in the developing rodent spinal cord.

Within the mammalian central nervous system (CNS), glutamate receptors play a fundamental role in excitatory neurotransmission and synaptic plasticity. Studies of the neonatal cerebral cortex suggests that rearing environment can influence the dynamic patterns of glutamate receptor subunit expression during development. We examined this issue in the developing spinal cord, a well studied region of the CNS in which activity-dependent synaptic plasticity is known to occur.We compared the abundance (by immunoblot analysis) and tissue distribution (by immunohistology) of glutamate receptor subunits in neonatal animals who participated in the Neurolab Space Shuttle mission. Flight animals were either postnatal day 8 or 13 at launch and spent the next 16 d in microgravity; tissues were recovered within 12 h of landing. Littermate control animals were reared on Earth at 1 G.Using semi-quantitative immunoblot assays, no statistically significant differences were found in the overall abundance of any glutamate receptor subunit in the spinal cords of the two groups of animals. Similarly, immunohistological examination of spinal cords revealed no evidence for differences in the distribution of glutamate receptor subunits between the two groups of animals.These results indicate that the developmental regulation of glutamate receptor subunit expression in the spinal cord is not appreciably affected by the conditions associated with this space shuttle mission and prolonged rearing period in microgravity.

Authors
Stegenga, SL; Eward, W; Kalb, RG
MLA Citation
Stegenga, SL, Eward, W, and Kalb, RG. "Shuttle mission effects on glutamate receptor expression in the developing rodent spinal cord." Aviation, space, and environmental medicine 74.6 Pt 1 (June 2003): 615-621.
PMID
12793531
Source
epmc
Published In
Aviation, space, and environmental medicine
Volume
74
Issue
6 Pt 1
Publish Date
2003
Start Page
615
End Page
621

Immunohistochemistry of the canine vomeronasal organ.

The canine's olfactory acuity is legendary, but neither its main olfactory system nor its vomeronasal system has been described in much detail. We used immunohistochemistry on paraffin-embedded sections of male and female adult dog vomeronasal organ (VNO) to characterize the expression of proteins known to be expressed in the VNO of several other mammals. Basal cell bodies were more apparent in each section than in rodent VNO and expressed immunoreactivity to anticytokeratin and antiepidermal growth factor receptor antibodies. The thin layer of neurone cell bodies in the sensory epithelium and axon fascicles in the lamina propria expressed immunoreactivity to neurone cell adhesion molecule, neurone-specific beta tubulin and protein gene product 9.5. Some neurones expressed growth-associated protein 43 (GAP43): and a number of those also expressed neurone-specific beta tubulin-immunoreactivity. Some axon fascicles were double labelled for those two proteins. The G-protein alpha subunits Gi and Go, involved in the signal transduction pathway, showed immunoreactivity in the sensory cell layer. Our results demonstrate that the canine vomeronasal organ contains a population of cells that expresses several neuronal markers. Furthermore, GAP43 immunoreactivity suggests that the sensory epithelium is neurogenic in adult dogs.

Authors
Dennis, JC; Allgier, JG; Desouza, LS; Eward, WC; Morrison, EE
MLA Citation
Dennis, JC, Allgier, JG, Desouza, LS, Eward, WC, and Morrison, EE. "Immunohistochemistry of the canine vomeronasal organ." J Anat 202.6 (June 2003): 515-524.
PMID
12846473
Source
pubmed
Published In
Journal of Anatomy
Volume
202
Issue
6
Publish Date
2003
Start Page
515
End Page
524

Effects of unilaterally restricted carpal range of motion on kinematic gait analysis of the dog

Decreased carpal range of motion is a common sequel to both disease and injury of the canine carpus; it is also encountered following therapeutic endeavours such as taping, bandaging, and arthrodesis. It was the aim of this study to define alterations of movement in dogs with artificially restricted carpal range of motion (ROM) by use of non-invasive, two-dimensional, computer-assisted kinematic gait analysis. Carpal taping was performed using strips of five centimetre adhesive porous bandage tape placed in circumferential, overlapping strips from mid-radius to just proximal to the metacarpal pad. Significant differences (p < 0.05) in angular displacement were observed, not only in the motion-restricted carpus, but also in the ipsilateral shoulder and contralateral stifle, demonstrating the need for monitoring of other joints when carpal ROM is restricted unilaterally either due to pathology, coaptation or arthrodesis.

Authors
Eward, C; Gillette, RL; Eward, W
MLA Citation
Eward, C, Gillette, RL, and Eward, W. "Effects of unilaterally restricted carpal range of motion on kinematic gait analysis of the dog." Veterinary and Comparative Orthopaedics and Traumatology 16.3 (2003): 158-163.
Source
scival
Published In
Veterinary and Comparative Orthopaedics and Traumatology
Volume
16
Issue
3
Publish Date
2003
Start Page
158
End Page
163
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