Archive for the ‘Artificial Knees and implants’ Category

Tumor Surgeon James C. Wittig, MD Featured in New York Magazine’s Best Doctors Issue for 2012

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Posted 30 Jun 2012 — by James Street
Category Artificial Knees and implants, Artificial limbs, Bone repair, Osteosarcoma, Osteosarcoma surgery, Osteosarcoma Treatment Centers

New York, NY (PRWEB) June 29, 2012

Dr. James C. Wittig has again been named a top orthopedic surgeon in New York magazine’s latest guide to the “Best Doctors in New York.” Time and again, Dr. James Wittig has earned the distinction of being among the finest in the country – and that’s according to leading physicians in his field.    Dr. Wittig, an Orthopedic Oncologist at Mount Sinai Medical Center, dedicates his practice exclusively to limb-sparing surgery; pediatric and adult bone and soft tissue sarcomas; benign musculoskeletal tumors; metastatic cancers; as well as complex hip and knee replacement surgery. In addition to his office at Mount Sinai Medical Center, Dr. Wittig sees patients at offices in Hackensack and Morristown, New Jersey as well as in Long Island, NY.

On any given day, you will find Dr. Wittig in surgery, making rounds or conferring with colleagues on the next best option for his patients. It is this assiduous schedule that keeps Dr. Wittig at the forefront of his field, earning him accolades yearly and again this year. In addition, he recently co-authored “Operative Techniques in Orthopaedic Surgical Oncology,” a much needed resource and whose time had come. Co-authored also by Martin Malawar, MD and Jacob Bickers, MD, the book was produced to provide a comprehensive guide on the surgical treatment for bone and soft tissue sarcoma and a heavy emphasis on limb sparing surgery.

He takes this accolade as another motivating force to continue to seek out and explore both new and technologically advanced medical treatments as well as share his experiences. The desire to help others coupled with his educational endeavors has grown tremendously from his roots as a child in Paterson to receiving his first honor in 1990, a Biology Department Honors Citation for Superior Academic Achievement followed by Summa Cum Laude status upon graduation from Seton Hall University. Four years later he received his Medical Degree from New York University School of Medicine where he was elected to the prestigious Alpha Omega Alpha (AOA) Honor Society and also served as president of the society. During medical school, he also received “Most Outstanding Research Presentation on Medical Student Assembly Day, The Lange Medical Publication Award for Outstanding Achievement as a Medical Student and the Glover C. Arnold surgical Award for the Medical Student who excelled in Surgery. From NYU he interned in General Surgery at St. Luke’s-Roosevelt Hospital Center and did his residency in Orthopaedic Surgery at Columbia Presbyterian Medical Center in New York City where he was appointed Administrative Chief Resident received the ‘Orren D. Baab Award for Excellence in Orthopedic Surgery, Member of the Senior Resident Staff who Best Exemplifies those Qualities of Academic Excellence, Clinical Proficiency and Capacity for Leadership, New York Orthopedic Hospital.’ Dr. Wittig continued to fine tune his surgical skills as a Fellow in Orthopedic Oncology at Washington Cancer Institute, Washington Hospital Center, Children’s National Medical Center, Armed Forces Institute of Pathology in Washington, DC as well as serve as a Sarcoma Consultant, Surgical Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.

The experience and accolades he has received along his medical journey has continued to enrich his desire to teach fellow colleagues as well as secure the best treatment options available for both adults and children affected by orthopedic tumors. While an Assistant Professor of Orthopedic Surgery at NYU Medical Center he received ‘Teacher of the Year for Outstanding Leadership, Guidance and Selfless Dedication to the Residents of NYU Hospital for Joint Diseases Department of Orthopedic Surgery Class of 2007.’     His desire was also transparent when he joined Mount Sinai Medical Center and was asked to develop a multidisciplinary team to treat sarcomas and other musculoskeletal tumors. In a two year span, he has performed over 600 cases and has dramatically changed the lives of those who have met him. Dr. Wittig has been instrumental in recruiting a team of specialists who focus on diagnosing and treating sarcomas as well as other types of bone and soft tissue tumors that affect the extremities, pelvis and spine. Currently, the team consists of specialized Pathologist Dr. Roberto Garcia; Musculoskeletal Radiologist Dr. Darren Fitzpatrick; Pediatric Oncologist Dr. Birte Wistinghausen and Radiation Oncologist Dr. Vishal Gupta as well as three Physician Assistants, 2 administrative assistants, a second orthopedic oncologist, Dr. Ilya Iofin and Dr. Sheeraz Qureshi, a spine surgeon focusing on a collaborative approach for spine tumors. The newest member to join Dr. Wittig’s team is renowned sarcoma cancer researcher and medical oncologist Dr. Robert Maki. Dr. Maki is also Chief of Pediatric Oncology and the Medical Director of the Sarcoma Program at Tisch Cancer Institute of Mount Sinai Medical Center. His vast array of experience, particularly his expertise in novel therapies for treating these complex sarcoma cancers, will ensure continuous research and development in this field.

James C. Wittig, MD specializes in limb-sparing surgery; pediatric and adult bone and soft tissue sarcomas; melanoma; benign musculoskeletal tumors; metastatic cancers; as well as complex hip and knee replacement surgery. He also has special expertise with regard to tumors that affect the shoulder girdle and scapula. In addition to his office at Mount Sinai Medical Center located at 5 East 98th Street, New York, NY, Dr. Wittig has satellite offices affiliated with Hackensack University Medical Center, at Continental Plaza, 433 Hackensack Avenue, 2nd Floor, Hackensack, NJ and Morristown Memorial Hospital, at NJ Advanced Musculoskeletal Center, PA, 131 Madison Avenue, Suite 130, Morristown, NJ and ProHealth in Long Island. Currently, Dr. Wittig is Associate Professor of Orthopedic Surgery, Chief of Pediatric and Adult Orthopedic Oncology and the Sarcoma Program at Mount Sinai Medical Center in New York City as well as Chief, Orthopedic Oncology and Director, Sarcoma Section of the Cancer Center, Hackensack University Medical Center. He is a member of the American Academy of Orthopedic Surgeons; New York State Society of Orthopedic Surgeons, Inc.; and the Medical Society of New Jersey. He has published over 90 educational materials ranging from original reports, abstracts, videos and articles in the following publications: Clinical Orthopedics and Related Research, The Journal of the American College of Surgeons, American Family Physician, Journal of Arthroplasty, Radiology and Journal of Bone and Joint Surgery. He is also a prominent lecturer in the field of Orthopedic Surgery throughout the nation.

For more information about this or other related topics, or to schedule an appointment, please call (212) 241-1807, visit http://www.TumorSurgery.org or email Dr. Wittig at drjameswittig(at)gmail(dot)com.

Read the full story at http://www.prweb.com/releases/2012/6/prweb9650840.htm

Failure Rate Varies With Expandable Femur Prostheses

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Posted 12 Feb 2012 — by James Street
Category Artificial Knees and implants, Osteosarcoma surgery

Laird Harrison

February 10, 2012 (San Francisco, California) — Three types of expandable femur prosthesis were similarly effective in patients with osteosarcoma, but the mechanical failure rate of the 3 devices varied, researchers reported here at the American Academy of Orthopaedic Surgeons (AAOS) 2012 Annual Meeting.

The 3 devices examined were the How-Medica Modular Resection System (Stryker Orthopaedics; Mahway, New Jersey), the Repiphysis (Wright; Arlington, Tennessee), and a device by Stanmore (Middlesex, United Kingdom).

“There were no significant differences between the 3 types of prostheses where the mean score or functional MSTS [American Musculoskeletal Tumor Society] was observed,” said Pietro Ruggieri, MD, PhD, chair of orthopaedic oncology at the Instituto Ortopedico Rizzoli in Bologna, Italy.

However, the 3 were not all alike in terms of function. The lengthening mechanisms in the Repiphysis and the Stanmore prostheses work by electromagnetism, so surgery is not necessary.

In the Stanmore prosthesis, surgeons periodically use a hexagonal key inserted through a 1 to 2 cm stab incision to telescopically extend the implant.

“The Stryker prosthesis, although it requires open lengthening procedures, has shown significantly fewer complications, compared with the Rephysis,” Dr. Ruggieri reported.

Overall, the researchers implanted 39 devices in 32 children with a mean age of 9 years at initial surgery.

Mean total lengthening of 26 mm was achieved with 78 procedures (2.4 procedures per patient).

The Stryker

The surgeons implanted 17 Stryker devices. They achieved a mean total lengthening of 5 cm, with a mean of 4 lengthenings. Mean lengthening per procedure was 1.5 cm.

The mean MSTS score was 24. There was 1 mechanical failure. Six patients achieved skeletal maturity.

The Wright

The surgeons implanted 15 Wright devices. They achieved a total lengthening of 3.6 cm with 3 lengthenings. Mean lengthening per procedure was 1 cm. One patient achieved skeletal maturity.

The meant MSTS score was 23.4. There were 5 mechanical failures, with an additional 2 failures after the researchers submitted their abstract. One patient achieved skeletal maturity.

The Stanmore

The Italian team implanted 7 Stanmore devices. They achieved a mean lengthening of 10 mm, with 4 mm per lengthening, but the follow-up time was shorter for this device, so it could not be directly compared with the other 2.

The mean MSTS score was 27.4. There were no mechanical failures, and no patients achieved skeletal maturity.

The Outcomes

Although all 3 devices achieved satisfactory lengthening, “the Repiphysis prosthesis had a dramatically, tremendously higher, radically higher incidence of mechanical failure,” said Dr. Ruggieri.

The difference in the survival rate of the Wright and Stryker devices was statistically significant (P = .026).

The differences in MSTS scores were not statistically significant between the groups (P = .934).

The follow-up time for the Repiphysis and Wright devices was 72 months. Dr. Ruggieri, who has submitted his results for publication, declined to disclose the follow-up time for the Stanmore device.

The findings came as no surprise to session moderator Bryan Scott Moon, MD, assistant professor of orthopedic oncology at the University of Texas M.D. Anderson Cancer Center in Houston.

“He kind of reaffirmed what we all knew — that there is a fairly high failure rate with these,” Dr. Moon told Medscape Medical News. He was not involved in the study.

The Stanmore results were tantalizing, Dr. Moon said. “Stanmore had a lower failure rate, but they have not done enough to know for sure. We are hoping eventually more data come out.”

Dr. Ruggieri and Dr. Moon have disclosed no relevant financial relationships.

American Academy of Orthopaedic Surgeons (AAOS) 2012 Annual Meeting: Abstract 167. Presented February 8, 2012.

Infected Total Femoral Replacements: Evaluation of Limb Loss Risk Factors

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Posted 04 Nov 2011 — by James Street
Category Artificial Knees and implants, Osteosarcoma surgery

Correspondence should be addressed to: Kathleen S. Beebe, MD, Department of Orthopaedic Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103 (beebeka@umdnj.edu).

Posted Online: November 09, 2011

With continuing advances in medical technology, limb salvaging has become a more common method of treatment in the orthopedic field. One method that has significantly benefited from recent advances is the use of implants after a large resection of bone that is typically caused by large bone neoplasms. Because the femur is one of the most common sites of primary bone sarcomas, 1-4 treatment of large femoral tumors was previously limited to hip disarticulation or hemipelvectomy. 5 Advancements in endoprosthetic implants, chemotherapy, radiation, and diagnostic imaging have allowed for massive bone resection of the femur caused by primary bone tumors to be treated with total femoral replacements (TFRs). 1,6-8 Total femoral replacement has not been limited to massive oncologic resections but has also found an application in nononcologic indications, such as failed total hip arthroplasty, osteomyelitis, and failed internal fixation. 5,9 Although no evidence of improvement in either quality of life or survival following limb salvage procedures exists, some studies have shown improvements in cost-effectiveness and overall function of the salvaged limbs. 7,8,10,11

Although TFR is an orthopedic advancement, this method has complications. One of the most unfavorable complications of TFR is failure due to acute or chronic periprosthetic infection. 6,7,12,13 However, to the authors’ knowledge, no studies that analyzed the possible risk factors for unsalvageable TFRs in individuals with periprosthetic infection have been published.

Materials and Methods

Approval for a retrospective chart review was obtained from the institutional review board, and data were collected from the New Jersey Medical School Orthopaedic Department surgical database from the years 2000 to 2010; 10 patients met the inclusion criteria of the study. The inclusion criteria of the study consisted of individuals with TFRs who subsequently were identified as having periprosthetic infections. Periprosthetic infection was defined as (1) the presence of a growth of microorganisms from a pre- or intraoperative joint aspiration; (2) purulence surrounding the prosthesis at the time of surgery; or (3) acute inflammation consistent with infection on histopathological examination. 14

Early infection was defined as periprosthetic infection occurring within 3 months of TFR surgery, whereas late infection was defined as an infection occurring 3 months after surgery. Recent history of infection was defined as an infection that was present within 6 months prior to the TFRs. Patients received either primary or secondary TFRs. Primary TFRs were defined as those performed in individuals who received a TFR as the primary method of treatment for the disease. Secondary TFRs were defined as TFRs that were implanted due to primary implant failure and further surgical or medical intervention to retain the patient’s primary implant was considered ineffective. The standard surgical technique for primary or revisional TFR was used on all patients.

The information collected from the 10 identified patients included age, primary diagnosis, hospital course, surgical management, and follow-up. These cases were divided into 2 groups: unsalvageable TFRs and salvageable TFRs. An unsalvageable TFR was defined as an infected TFR that resulted in a hip disarticulation, hemipelvectomy, or removal of the TFR with no ability to reimplant the endoprosthesis. A salvageable TFR was defined as an infected TFR that was successfully retained. The indications for amputation were for patients who had infected TFRs that could not be managed by antibiotics or surgery and further surgical or medical intervention was deemed to be ineffective.

Statistical analysis was performed using the Fischer’s exact test, and a P value of <.05 was considered statistically significant when risk factors were assessed.

Results

There were 24 patients with TFRs seen at our institution between 2000 and 2010. Fourteen of these patients were not included in this study due to a lack of history of periprosthetic infection. Of the 10 patients who had TFRs with periprosthetic infections, 5 were women and 5 were men and their mean age was 44.3 years (range, 9-78 years).

Four of the tenpatients received primary TFRs. Three of these patients were diagnosed with osteosarcoma, and 1 was diagnosed with Ewing’s sarcoma. Six patients received secondary TFRs. Of these, 4 had failed total hip arthroplasties secondary to periprosthetic infection, 1 had a failed proximal femoral replacement secondary to aseptic loosening, and 1 had a failed distal femoral replacement secondary to periprosthetic fracture. Mean postoperative follow-up for the patients with infected TFRs was 10.5 months (range, 3-22 months). Patients who had unsalvageable TFRs had a mean of 12 weeks from last surgery to amputation. For the 3 patients with salvaged TFRs, follow-up time following treatment of the infection was 6, 34, and 36 months, respectively. One patient succumbed to his primary disease, osteosarcoma, within 6 months of his periprosthetic infection.

In 9 of 10 patients, positive cultures were found consisting of the following microorganisms: coagulase-negative Staphylococci (n=4), Enterococcus species (n=3), Staphylococcus aureus (n=1), and Pseudomonas aeruginosa (n=1). The 1 patient with negative cultures had histological evidence of osteomyelitis, as well as pain and persistent fluid collection around the TFR.

Seven of 10 unsalvageable TFRs were due to infection. The 2 greatest risk factors for unsalvageable TFRs were age older than 50 years (Figure 1) and recipients of secondary TFRs (Figure 2). All 6 patients older than 50 years had unsalvageable TFRs, whereas 1 of 4 patients younger than 50 years had an unsalvageable TFR (P<.05). Similarly, all 6 patients who received secondary TFRs had unsalvageable TFRs, whereas 1 of 4 patients who received a primary TFR had an unsalvageable TFR (P<.05). All results are shown in the Table.

Percentage of salvageable and unsalvageable TFRs in patients younger than 50 years vs patients 50 years and older. Figure 1: Percentage of salvageable and unsalvageable TFRs in patients younger than 50 years vs patients 50 years and older.

Percentage of salvageable and unsalvageable TFRs in primary vs secondary TFRs. Figure 2: Percentage of salvageable and unsalvageable TFRs in primary vs secondary TFRs.

Results of Risk Factor Analysis for Unsalvageable TFR Following Periprosthetic Infection Table: Results of Risk Factor Analysis for Unsalvageable TFR Following Periprosthetic Infection

Sex, number of irrigation and debridements, recent history of a periprosthetic infection, early vs late periprosthetic infection after TFR surgery, use of antibiotic cement, and number of postoperative antibiotics did not show statistical significance and could not be identified as possible risk factors (Table).

Discussion

Prior to the use of TFRs, treatment following a massive resection of the femur was limited to limb amputation, leaving patients with functional deficits of the lower limb. 6 The development of endoprosthesis in limb salvaging has allowed for the TFR to become an accepted method of treatment following large resections of the femur. This allows physicians to preserve significant function in the lower extremities of their patients. 1,9 Although no evidence of improvement in either quality of life or survival when comparing limb salvaging to amputation exists, 11 studies have shown overall functional improvement of the salvaged limbs prior to the patient having surgery. 7,8,15,16

The complexity of the TFR procedure, as well as the high-risk nature of the patient population (eg, immunocompromised individuals, elderly) in which the treatment has been used led to predictable complications. The complications typically seen with TFRs include dislocation of the hip, superficial and deep infection, periprosthetic fracture, local recurrence of tumor, and joint pain. Of these complications, tumor recurrence and deep wound infection have been shown to increase the risk of amputation. 8,17-19

Studies have shown infection rates in TFRs to be between 3% and 36.7%. 5-8,12,16,18,20 In a large study of orthopedic oncologic patients by Jeys et al, 17 the researchers reported that individuals with infected endoprosthesis had a 19% rate of amputation due to infection. Due to the lack of large TFR case studies, the percentage of unsalvageable TFRs caused by infection has never been properly addressed. Our studies demonstrated a significant number of unsalvageable TFRs following infection (70%), thus making the understanding of risk factors for unsalvageable TFR following infection important.

The current study examined multiple possible risk factors, including age, sex, secondary TFRs, number of irrigation and debridements, recent history of periprosthetic infection, early vs late infection, use of antibiotic cement, and number of postoperative antibiotics. From these variables, patients older than 50 years and receipt of secondary TFRs had the greatest risks for an unsalvageable TFR following a periprosthetic infection.

Ward et al 6 reported 3 cases of deep tissue infection in their study of 21 cases of TFRs. Two of 3 patients, both older than 50 years, needed hip disarticulations, whereas the remaining 1 (aged 26 years) resulted in a salvaged TFR. Nerubay et al 12 also reported the case of a 55-year-old patient with a deep tissue infection among the 19 cases of TFRs that could not be controlled and resulted in amputation. These studies, along with the current study, suggest that an older age poses a greater risk for unsalvageable TFR following a periprosthetic infection. The increased risk for unsalvageable TFRs following periprosthetic infection in the older population can be attributed to multiple factors (eg, decreased immuno-responsiveness, greater comorbidities, and difficulties in activities of daily life). These factors were not assessed in this study.

In a study of revision arthroplasty to TFR by Frieseke et al, 18 the researchers found the rate of unsalvageable TFRs following periprosthetic infections to be 17%, with all patients having negative cultures for microorganisms at the time of revision surgery. These patients received TFRs due to failure of their original endoprosthesis. Although our rate of unsalvageable secondary TFRs following periprosthetic infections was found to be much higher, 4 of the 10 patients in our study had a recent infection of their endoprosthesis that necessitated the need for conversion to TFRs. This factor may contribute to the higher rate of incidence of unsalvageable secondary TFRs following periprosthetic infections.

The study by Ward et al 6 on TFRs reported 8 cases of TFRs that were used following failed subtotal femoral endoprosthesis. Two of these patients had periprosthetic infections following their surgical revision to TFRs, and of these 2 patients, 1 had an unsalvageable TFR. Although both studies demonstrated lower rates of unsalvageable TFRs than the authors’ study, they both demonstrate concerning rates of unsalvageable TFRs when TFRs are used as revision surgeries and are then followed by periprosthetic infections. One possible reason for this high rate of unsalvageable TFRs could be that multiple endoprosthetic surgeries, as well as periprosthetic infections, may cause soft tissue damage, making proper soft tissue coverage difficult. Studies by Hardes et al 21 and Grimer et al 22 reported that inadequate soft tissue coverage in tumor patients with endoprosthesis poses a higher risk of implant failure following infection.

Although other risk factors were studied in the authors’ research, these did not show statistical significance. The authors note that, although not statistically significant, all individuals who had recent histories of deep tissue infections at the time of initial TFR surgery and went on to have infected TFR had unsalvageable TFRs (n=4).

There are several limitations to the current study. Due to the specific inclusion criteria of this study, the research was restricted to a small number of cases. This made enhanced statistical analyses, such as multivariant analysis, difficult. Also, it should be noted that the lack of statistical significance in multiple risk factors in this study may be the result of the limited sample size and not a clear indication that these risk factors did not at all influence the failure rates of TFRs. In addition, the small number of cases also limited the authors’ ability to assess comorbidities that influence infection, such as smoking, diabetes mellitus, and rheumatoid arthritis. Finally, this study included patients with varying diseases (oncologic and nononcologic), with each patient having a different disease process. Due to the brief follow-up time and the limited number of patients, the effect of each disease on TFRs could not be addressed.

The authors stress the importance of evaluating risk factors for unsalvageable TFRs. Patients who may fall into high-risk categories (those older than 50 years and recipients of secondary TFRs) may benefit from physician education regarding the advantages of early interventions, such as amputation, that could prevent additional surgeries and decrease the lengths of hospitalizations. In addition, preventing infection in TFRs in all patients is important, but particularly so in patients who have a higher risk for unsalvageable TFRs following periprosthetic infection.

References

    1. Bielack SS, Kempf-Bielack B, Delling G, et al. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol. 20(3):776-790.

    1. Schwartz HS. Musculoskeletal Tumor Society. In: Herbert S, Schwartz HS, eds. Orthopaedic Knowledge Update: Musculoskeletal Tumors 2. 2nd ed. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2007:143-205.

    1. Unni KK, Inwards CY. Dahlin’s Bone Tumors: General Aspects and Data on 10,165 Cases. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010.

    1. Gibbs CP Jr, Weber K, Scarborough MT. Malignant bone tumors. Instr Course Lect. 2002; 51:413-428.

    1. Bickels J, Meller I, Henshaw R, Malawar MM. Proximal and Total Femur Resection with Endoprosthetic Reconstruction. In: Malawar MM, Sugarbaker PH, eds. Musculoskeletal Cancer Surgery. Treatment of Sarcomas and Allied Diseases. Boston, MA: Kluwer; 2001:438-456.

    1. Ward WG, Dorey F, Eckardt JJ. Total femoral endoprosthetic reconstruction. Clin Orthop Relat Res. 1995; (316):195-206.

    1. Ruggieri P, Bosco G, Pala E, Errani C, Mercuri M. Local recurrence, survival and function after total femur resection and megaprosthetic reconstruction for bone sarcomas. Clin Orthop Relat Res. 2010; 468(11):2860-2866. doi:10.1007/s11999-010-1476-4 [CrossRef]

    1. Sewell MD, Spiegelberg BG, Hanna SA, et al. Total femoral endoprosthetic replacement following excision of bone tumours. J Bone Joint Surg Br. 2009; 91(11):1513-1520. doi:10.1302/0301-620X.91B11.21996 [CrossRef]

    1. Freedman EL, Eckardt JJ. A modular endoprosthetic system for tumor and non-tumor reconstruction: preliminary experience. Orthopedics. 1997; 20(1):27-36.

    1. Grimer RJ, Carter SR, Pynsent PB. The cost-effectiveness of limb salvage for bone tumours. J Bone Joint Surg Br. 1997; 79(4):558-561. doi:10.1302/0301-620X.79B4.7687 [CrossRef]

    1. Refaat Y, Gunnoe J, Hornicek FJ, Mankin HJ. Comparison of quality of life after amputation or limb salvage. Clin Orthop Relat Res. 2002; (397):298-305. doi:10.1097/00003086-200204000-00034 [CrossRef]

    1. Nerubay J, Katznelson A, Tichler T, Rubinstein Z, Morag B, Bubis JJ. Total femoral replacement. Clin Orthop Relat Res. 1988; (229):143-148.

    1. Lavoie G, Healey HJ, Lane JM, Marcove RC. Prosthetic total femur replacement following massive resection for sarcoma. In: Brown K, ed. Complications of Limb Salvage: Prevention, Management, and Outcomes. Montreal, Quebec, Canada: ISOLS; 1991:129-132.

    1. Tattevin P, Crémieux AC, Pottier P, Huten D, Carbon C. Prosthetic joint infection: when can prosthesis salvage be considered? Clin Infect Dis. 1999; 29(2):292-295. doi:10.1086/520202 [CrossRef]

    1. Ahmed AR. Total femur replacement [published online ahead of print July 31, 2009]. Arch Orthop Trauma Surg. 2010; 130(2):171-176. doi:10.1007/s00402-009-0945-2 [CrossRef]

    1. Fountain JR, Dalby-Ball J, Carroll FA, Stockley I. The use of total femoral arthroplasty as a limb salvage procedure: the Sheffield experience. J Arthroplasty. 2007; 22(5):663-669. doi:10.1016/j.arth.2006.11.017 [CrossRef]

    1. Jeys LM, Grimer RJ, Carter SR, Tillman RM. Risk of amputation following limb salvage surgery with endoprosthetic replacement, in a consecutive series of 1261 patients [published online ahead of print February 8, 2003]. Int Orthop. 2003; 27(3):160-163.

    1. Friesecke C, Plutat J, Block A. Revision arthroplasty with use of a total femur prosthesis. J Bone Joint Surg Am. 2005; 87(12):2693-2701. doi:10.2106/JBJS.D.02770 [CrossRef]

    1. Ghert MA, Harrelson JM, Scully SP. Total femoral replacement. Oper Tech Orthop. 1999; 9(2):121-127. doi:10.1016/S1048-6666(99)80031-7 [CrossRef]

    1. Henderson ER, Groundland JS, Pala E, et al. Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am. 2011; 93(5):418-429. doi:10.2106/JBJS.J.00834 [CrossRef]

    1. Hardes J, Gebert C, Schwappach A, et al. Characteristics and outcome of infections associated with tumor endoprostheses [published online ahead of print April 21, 2006]. Arch Orthop Trauma Surg. 2006; 126(5):289-296. doi:10.1007/s00402-005-0009-1 [CrossRef]

  1. Grimer RJ, Belthur M, Chandrasekar C, Carter SR, Tillman RM. Two-stage revision for infected endoprostheses used in tumor surgery. Clin Orthop Relat Res. 2002; (395):193-203. doi:10.1097/00003086-200202000-00022 [CrossRef]

Clinical characteristics and prognosis of osteosarcoma in young children under five: a retrospective series of 15 cases

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Posted 25 Sep 2011 — by James Street
Category Age and osteosarcoma, Artificial Knees and implants, Artificial limbs, Osteosarcoma, Osteosarcoma Outcomes

Osteosarcoma is the most common primary bone malignancy in childhood and adolescence. However, it is very rare in children under 5 years of age.

Although studies in young children are limited in number, they all underline the high rate of amputation in this population, with conflicting results being recently reported regarding their prognosis.

Methods: To enhance knowledge on the clinical characteristics and prognosis of osteosarcoma in young children, we reviewed the medical records and histology of all children diagnosed with osteosarcoma before the age of five years and treated in SFCE (Societe Francaise des Cancers et leucemies de l’Enfant) centers between 1980 and 2007.

Results: Fifteen patients from 7 centers were studied. Long bones were involved in 14 cases.

Metastases were present at diagnosis in 40% of cases. The histologic type was osteoblastic in 74% of cases.

Two patients had a relevant history. One child developed a second malignancy 13 years after osteosarcoma diagnosis.Thirteen children received preoperative chemotherapy including high-dose methotrexate, but only 36% had a good histologic response.

Chemotherapy was well tolerated, apart from a case of severe late convulsive encephalopathy in a one-year-old infant. Limb salvage surgery was performed in six cases, with frequent mechanical and infectious complications and variable functional outcomes.Complete remission was obtained in 12 children, six of whom relapsed.

With a median follow-up of 5 years, six patients were alive in remission, seven died of their disease (45%), in a broad range of 2 months to 8 years after diagnosis, two were lost to follow-up.

Conclusions: Osteosarcoma seems to be more aggressive in children under five years of age, and surgical management remains a challange.

Author: Maud GuillonPierre MaryLaurence BrugierePerrine Marec-BerardHelene PacquementClaudine SchmittJean-Marc GuinebretiereMarie-Dominique Tabone
Credits/Source: BMC Cancer 2011, 11:407

Taking chances, pursuing success

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Posted 12 Sep 2011 — by James Street
Category Artificial limbs, Biomedical Engineering, Follow up Treatment, Local Recurrence, Lung Metastases, Osteosarcoma, Osteosarcoma Outcomes, Relapse
By Kody Klein | THE EASTERN ECHO
Added September 11, 2011 at 9:30 pm

September 11 is a bittersweet day of remembrance for Eastern Michigan University student Andrew Samuels — not only because of the tragic events that took place that day, but because of a more personal loss — his left leg.

Samuel, a 23-year-old junior majoring in engineering physics, had his leg amputated as a last-ditch effort to eradicate the osteosarcoma that began in his left femur.

DSC_8808

Lukas Burch / THE EASTERN ECHO

“I was ten years old when I found out I had cancer,” Samuels said. “I was diagnosed at Mott Children’s Hospital by doctors from the University of Michigan.”

Samuels, a warm, outgoing and physically-active ten-year-old, was overwhelmed most by the desolate reality of being condemned to a hospital bed for the last remaining years of his childhood.

“I didn’t really understand what cancer was at first, but I understood that I was going to have to stay in the hospital for a very long time,” Samuels said.

“It wasn’t so much the fact that I realized that I could actually die at some point in my life. It was more that this was going to completely transform my life to the extent that I couldn’t be the kid that I wanted to be. I just wanted to be a normal kid. I was at school, I had all kinds of friends, I wanted to run around, I wanted to play sports, but I had to grow up. Week after week in a hospital bed, a large part of my childhood was gone.”

Samuels’ grueling struggle with cancer continued for four years. At first, doctors didn’t think amputation would be necessary.

“They tried what’s called ‘limb salvage,’” Samuels said. “They took out the femur and replaced it with a metal one. I had that for a while, and I was still on two legs. But the cancer came back two years later. Not only it had spread upward, but it was in my lungs as well.”

Samuels was 12 when the doctors informed him the cancer had returned, had spread and that amputating his leg was now the best way to combat the cancer. Yet somehow, at an age when most adolescents are playing video games, obsessing over acne and nursing quiet infatuation, he received the news without flinching.

“I was cool with it,” Samuels said. “That was about two years into my cancer battle, so I was pretty battle-hardened by then. At that point I had the perspective, ‘Let’s just do what it takes to get this done. Bring it on.’ I was talking with my doctors and I told them, ‘If this is what you guys think is the best route to go and the best way to end this right now, then let’s do it.’“

Amputating his leg proved to be a prudent decision. Samuels ultimately won the war and has been cancer-free for a decade. His last surgery was Sept. 11, 2001.

“We were walking through the hospital and everybody was standing around looking at the TV,” Samuels said. “Obviously, the planes had hit the towers. My doctor was watching as well in the lobby. It was really impressive. He said, ‘Andrew, we’re not going to worry about what’s going on right now. We’re going to focus on you.’ So he turned off the television and he said, ‘This is our day. We’re going to get you fixed up.’ I was really impressed by that, and I’ll always have respect for UM doctors.”

Victory over cancer has had a profound effect on Samuels’ outlook on life.

“Through my experience, I developed the perspective that I don’t believe in giving up on anything,” Samuels said. “No matter what adversity you’re facing, why would you ever give up? The moment you give up, the chance of your succeeding is zero. Even if the chance of succeeding is so very small, there’s still that chance. So you take the shot. No matter what.”

This fierce practical optimism ultimately played a large role in Samuels’ decision to resume his education by enrolling at Eastern Michigan University.

“I used to think I could never ever do math and physics,” Samuels said. “I was terrible at it in high school, but it was because I didn’t think I could do it.

“After I graduated, I started my own Internet marketing company. I did that for two years, made a little money, and I thought, ‘If I can run a business and be somewhat successful at it, what else can I do? What can’t I do?’ So I came back to school. Again, I was just challenging all of my previous roadblocks that I thought were roadblocks but really weren’t, and realizing that even if they were, I could jump over them.”

One can’t help but feel impressed by Samuels. For someone who never considered himself to be proficient at math or physics, he’s made tremendous accomplishments.

He’s currently researching space weather in Earth’s upper atmosphere for Dr. David Pawloski. As if that isn’t impressive enough, Samuels hopes to use his degree to further the technology to provide people with comfortable and affordable robotic prosthetics.

“I have a prosthetic,” Samuels said. “However, the technology right now for people who are amputated at the hip is not good. It’s really uncomfortable and they’re really heavy and cumbersome. The computerized ones are starting to take off, but they’re very expensive and most insurance companies won’t even pay for them. Part of the reason I’m in engineering physics is that, if I have that sort of background, maybe I can build my own.”

Samuels’ ability to persevere through life’s most daunting tribulations with a smile and his head held high is something to revere. Perhaps most admirable of all is his eagerness to give back to the hospital that saved his life.

“I volunteer there now on Thursday nights,” Samuels said.

“The UM athletes come up for a program called Michigan From the Heart. Along with the Thursday night visits to Mott Children’s Hospital, the program also organizes trips to take the kids to the games and setup meetings between them and the players afterwards, so they can get autographs and photos. It’s a really cool thing to be a part of and I get to share my experience with kids who have the same type of cancer I had.

“It took me awhile to be convinced to ever go back to the hospital. After my treatment, spending four or five years there, why would I want to go back? But I realized I had a lot to share and I thought I could make someone else’s experience a little better by sharing mine with them.”

Samuels is truly an inspiration, like a prize-fighting boxer swinging until he collapses.

“I feel like if there’s that chance, you should take it,” he said. “I mean it’s life and death. Quite literally in my experience.”

Lab-Made Trachea Saves Man

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Posted 08 Jul 2011 — by James Street
Category Artificial Knees and implants, Bone repair, Limb and organ Regeneration

Tumor-Blocked Windpipe Replaced Using Synthetic Materials, Patient’s Own Cells

By GAUTAM NAIK

Doctors have replaced the cancer-stricken windpipe of a patient with an organ made in a lab, a landmark achievement for regenerative medicine. The patient no longer has cancer and is expected to have a normal life expectancy, doctors said.

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David GreenA lab-made windpipe was implanted June 9 into a 36-year-old patient whose own windpipe was obstructed by a tumor.

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“He was condemned to die,” said Paolo Macchiarini, a professor of regenerative surgery who carried out the procedure at Sweden’s Karolinska University Hospital. “We now plan to discharge him [Friday].”

The transplantation of an entirely synthetic and permanent windpipe had never been successfully done before the June 9 procedure. The researchers haven’t yet published the details in a scientific journal.

The patient’s speedy recovery marks another milestone in the quest to make fresh body parts for transplantation or to treat disease. More immediately, it offers a possible treatment option for thousands of patients who suffer from tracheal cancer or other dangerous conditions affecting the windpipe.

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Associated PressPaolo Macchiarini, a professor of regenerative surgery, carried out the procedure.

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“It’s yet another demonstration that what was once considered hype [in the field of tissue engineering] is becoming a life-changing moment for patients,” said Alan Russell, director of the McGowan Institute for Regenerative Medicine in Pittsburgh, who wasn’t involved in the latest operation.

In 2006, researchers disclosed how they had implanted lab-grown bladders into children and teens with spina bifida, a birth defect. And in 2008, members of a team that included Dr. Macchiarini said they had given a patient a new windpipe made partly from her own cells, and partly from “scaffolding” material taken from a cadaver.

The latest experiment shows that a fully functioning windpipe can be manufactured in the lab without the need for a cadaver.

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“It makes all the difference,” said Dr. Macchiarini. “If the patient has a malignant tumor in the windpipe, you can’t wait months for a donor to come along.”

The patient in this case is a 36-year-old Eritrean man, identified by doctors as a father of two studying geology in Iceland. Surgery and radiation treatments failed to stem a cancerous growth in his windpipe.

When the tumor reached about six centimeters in length, it almost completely blocked the trachea, or windpipe, making it hard for the patient to breathe.

With no suitable donor windpipe available, the final option was to try to build one from scratch. Dr. Macchiarini had good reason to feel emboldened: He had successfully transplanted cadaver-based windpipes in 10 patients.

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David GreenThe patient is expected to be released from the hospital Friday.

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The windpipe is a hollow tube, about 4.5 inches long, leading to the lungs. A key part of it is a scaffold—which functions like a skeleton for the organ—consisting of tissues such as cartilage and muscle. As a first step, a team led by Alexander Seifalian of University College London used plastic materials and nanotechnology to make an artificial version of the scaffold in the lab. It was closely modeled on the shape and size of the Eritrean man’s windpipe.

Meanwhile, researchers at Harvard Bioscience Inc. of Holliston, Mass., made a bioreactor, a shoe-box-size device similar to a spinning rotisserie machine. The artificial scaffold was placed on the bioreactor, and stem cells extracted from the patient’s bone marrow were dripped onto the revolving scaffold for two days.

With the patient on the surgery table, Dr. Macchiarini and colleagues then added chemicals to the stem cells, persuading them to differentiate into tissue—such as bony cells—that make up the windpipe.

Related

In a notable advance in organ transplants, surgeons at UC Davis Medical Center have restored the voice of a woman who couldn’t speak on her own through a transplant of the larynx, thyroid and trachea. Avery Johnson has details.

About 48 hours after the transplant, imaging and other studies showed appropriate cells in the process of populating the artificial windpipe, which had begun to function like a natural one. There was no rejection by the patient’s immune system, because the cells used to seed the artificial windpipe came from the patient’s own body.

Dr. Russell of the McGowan Institute sounded a note of caution about using this technique to build more-complex organs. For example, while tissue engineering can help to build hollow organs such as a windpipe, it will likely prove a bigger challenge to use the technique for creating the heart, which has much thicker tissue.

Dr. Macchiarini said he planned to use the same windpipe-transplant technique on three more patients, two from the U.S. and a nine-month-old child from North Korea who was born without a trachea.

Write to Gautam Naik at gautam.naik@wsj.com

Leg attached backward lets teen Dugan Smith return from cancer treatment to ballfield

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Posted 09 May 2011 — by James Street
Category Artificial Knees and implants, Artificial limbs, Bone repair, Osteosarcoma surgery
Published: Monday, May 09, 2011, 3:46 PM     Updated: Monday, May 09, 2011, 4:30 PM

By Plain Dealer staff

FOSTORIA, Ohio — A rare and radical surgery is helping a 13-year-old Fostoria boy survive bone cancer and keep up an active life with the healthy parts of his right leg, doctors told his hometown paper.

In 2008, when he was 10, Dugan Smith was diagnosed with osteosarcoma, the most common bone cancer in children. His knee and part of his thigh had to be amputated. But rather than have his movements limited, Dugan opted for “rotationplasty,” which turned his lower leg around, attached it to the remainder of his thigh and allowed his ankle to take over in place of his knee.

The Tiffin Advertiser-Tribune began the story in 2008.

In April, the Columbus Dispatch picked up the tale:

Less than three years after doctors from Ohio State University Medical Center amputated much of his right leg to remove a softball-size tumor from above his right femur (thighbone), Dugan plays baseball and basketball, went skiing last week, and plans to go out for freshman football in the fall.

The Fostoria Review-Times explained more last week:

“The foot fits into a prosthetic and allows him to expend much less energy walking than if he had opted to simply amputate the diseased portion of his leg.”

But the leg does look strange.

“Initially, they were just like any one would be when you describe the surgery, they were taken aback,” Dr. Joel Mayerson, an orthopedic oncologist at the Arthur G. James Cancer Hospital told the R-T. “But, they understood it would bring Dugan back to the most functional state.”

“… For Dugan, it was a no-brainer.”

Now an unusually determined seventh-grader, Dugan pitches and plays first base for the Fostoria Junior Redmen, and continues to work to strengthen his hip and leg.

An Ohio State Medical Center oncologist talks about the case:

Cancer Patient’s Lower Body Rebuilt With Bone Autografts and Titanium

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Posted 08 May 2011 — by James Street
Category Artificial Knees and implants, Artificial limbs, Bone repair, experimental treatments

Posted By Scott Jung On May 6, 2011 @ 12:00 am In in the news… | No Comments

What is being hailed as the first of its kind surgery here in the United States, a multi-disciplinary team of oncologists, urologists, neurosurgeons, plastic surgeons and general surgeons from The Ohio State University Comprehensive Cancer Center have successfully rebuilt the pelvis of a cancer patient out of bones from his own amputated leg. Even more remarkable than the sheer engineering complexity of the pelvic device is the fact that the patient, now considered a cancer survivor, is almost able to walk without any assistance.
Mike Prindle was an Ohio mail carrier who developed a chondrosarcoma tumor on his pelvis and sacrum that necessitated the removal of the malignant part of his pelvis, and the amputation of his left leg. However, instead of discarding the amputated limb, doctors kept the femur, fibula, and their surrounding blood vessels, muscles, and skin, which were unaffected by the cancer. They then engineered a custom device consisting of the salvaged leg bones, two large rods and a couple of smaller rods fixed to the pelvis and spine with 14 screws to help provide support.
Most patients who receive a similar device made of cadaver bones or artificial materials are confined to wheelchairs for the rest of their lives because the reconstructed pelvis does not heal strongly enough to support a person’s body weight. However, Prindle’s own bones fused together to create a pelvic ring strong enough to allow him to walk again using a prosthetic leg. The prosthetic leg, a C-Leg [1] from Germany based Otto Block, contains mini-computers at the hip joint, knee joint and foot to analyze his gait, reducing the amount of strain on the prosthetic and allowing him to walk with greater ease.

Article from OSUCCC: Ohio State Surgeons Rebuild Pelvis Of Cancer Patient… [2]
Medgadget’s Otto Bock archives… [3]

Ohio State Performs Rare ‘Rotation’ Surgery On Cancer Patient

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Posted 01 Apr 2011 — by James Street
Category Artificial Knees and implants, Bone repair, Limb and organ Regeneration, Surgery

By Ohio State University Comprehensive Cancer Center
Apr 1, 2011 – 7:08:26 AM

(HealthNewsDigest.com) – COLUMBUS, Ohio– Two years ago, Dugan Smith, an athletic and active fourth-grader, fell and broke his femur, revealing a softball-sized tumor just above his knee. Now, after undergoing a unique surgery in which his lower leg was amputated, the tumor removed, and the leg rotated and reattached so that his ankle now functions as his knee, Smith, 13, is cancer-free and back to the activities he loves – playing basketball and baseball.

After the shock of learning their son had osteosarcoma, a rare cancer that attacks the bones, his parents opted for the unusual surgical procedure to increase his chance not only of survival, but to help him return to an active lifestyle. Fewer than 12 rotationplastysurgeries are performed each year in the United States.

“For an active child, the rotationplasty surgery can be the best option,” said Dr. Joel Mayerson,Smith’s orthopaedic oncologist at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richad J. Solove Research Institute. “The fact that he is out playing baseball and living his life like a normal teen-ager, speaks to the success of the surgery and his determination to overcome all odds to do something he truly loves.”

The rotationplasty procedure allows doctors to remove the diseased portion of the patient’s leg, in Smith’s case, the middle section including his knee. The lower leg is turned backwards and reattached to the area just above where the tumor had been removed. By rotating the leg, Smith’s calf muscle now serves as his thigh, while his ankle and foot act as his knee and shin. He has been fitted with a prosthetic leg that fits over his foot and ankle, allowing him to walk, run and play sports. Smith is now the star pitcher of his middle school baseball team in Fostoria, Ohio.

“Unlike adults, children can re-train their body to make their foot work like a knee, enabling them to run and participate in athletic activities,” said Mayerson, who is one of only 125 fellowship-trained musculoskeletal oncologists nationwide. “Having this procedure also eliminates the need for follow-up surgeries as the child continues to grow, because the bone will grow on its own as the child ages, and there aren’t any artificial parts to break or become damaged with wear.”

While the procedure is rare and may be considered extreme, research shows that patients report a high level of quality of life and psychological satisfaction.

The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (cancer.osu.edu) is one of only 40 Comprehensive Cancer Centers in the United States designated by the National Cancer Institute. Ranked by U.S. News & World Report among the top cancer hospitals in the nation, The James is the 205-bed adult patient-care component of the cancer program at The Ohio State University. The OSUCCC – James is one of only five centers in the country funded by the NCI to conduct both phase I and phase II clinical trials.

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Colorado State University’s Withrow Honored with Lifetime Achievement Award

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Posted 04 Feb 2011 — by James Street
Category Artificial Knees and implants, Bone repair, Cat osteosarcoma, Dog Osteosarcoma, Osteosarcoma, Surgery

FORT COLLINS – Dr. Steve Withrow, professor of surgical oncology and founder and associate director of the Animal Cancer Center at Colorado State University, recently was honored with the Theilen Tribute Award for Lifetime Achievement at the 30th Annual Veterinary Cancer Society conference.

Withrow received the Theilen Tribute Award for Lifetime Achievement for setting the foundation for veterinary oncology, initiating pioneering research and for advancing clinical veterinary oncology.

Withrow was cited for the brilliance of his surgical skills, passion for teaching veterinary students and graduate veterinarians, the inspiration of his leadership and the visionary spirit of developing one of the first medical oncology residency and surgical oncology fellowship programs. He also was recognized for his humanity and compassion in helping cancer patients – animal or human – get the information, diagnostics and treatment they need.

Withrow, considered one of the founding fathers of modern veterinary oncology, was introduced at the conference as the “most influential and accomplished living veterinary oncologist.” His contributions to cancer research, especially in the area of bone cancer diagnostics and treatment, have been noteworthy.

Withrow pioneered a treatment that may prevent amputation in bone cancer patients. The alternative treatment to amputation removes cancerous bones in the limbs of cats and dogs and replaces them with bones from another animal. The treatment was developed in parallel and collaboratively with human limb-sparing research. The procedure has been adopted by cancer treatment centers across the nation and has been highly successful in preventing amputations in children diagnosed with osteosarcoma.

Withrow has worked to secure the future growth of veterinary oncology by working with others to establish the Veterinary Cooperative Oncology Group and the Veterinary Society of Surgical Oncology. Withrow and fellow pioneer radiation oncologist, Dr. Ed Gillette, and others established the first true comprehensive cancer center in veterinary medicine, the Colorado State University Animal Cancer Center.

Withrow has been with the Colorado State Veterinary Teaching Hospital since 1978. He was recently named the director of the CSU Academic Cancer Supercluster and the chief scientific officer of NeoTREX, the enterprise arm of the Supercluster. He also is a Colorado State University Distinguished Professor, Stuart University Chair in Oncology and is the only veterinarian admitted as a member of the Musculoskeletal Tumor Society.

Withrow also presented a keynote address at the conference, held in October in San Diego, in which he reflected on his career and privilege of being a veterinarian.

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