Athanasios Foukas - Academia.edu (original) (raw)

Papers by Athanasios Foukas

Orthopaedic Proceedings, Mar 1, 2005

Injury-international Journal of The Care of The Injured, Sep 1, 2011

Journal of Research and Practice on the Musculoskeletal System, Sep 1, 2019

The total annual number for total hip and knee replacement, for patients suffering from osteoarth... more The total annual number for total hip and knee replacement, for patients suffering from osteoarthrosis is about 1.000.000 in the USA 5. About 2.5 million (1.4 million of women and 1.1 million of men) patients submitted for total hip replacement and 4.7 million (3 million of women and 1.7 million of men) for total knee replacement in USA in 2010 6. The prevalence for total joint replacement in USA is 5.26% for hips and 10.38% for knees 6 .

Injury-international Journal of The Care of The Injured, Sep 1, 2011

sustained a pertrochanteric fracture. The mean age of these patients at the time of admission was... more sustained a pertrochanteric fracture. The mean age of these patients at the time of admission was 74 year old. All patients were treated surgically with internal fixation using short cephalocondylic nails. By the time of a standardised follow up visit at least 5 years after the operation, 30 of these patients had died. The remaining 216 patients were evaluated clinically and radiographically, using Harris Hip Score to assess postoperative functionality and standard x-ray check of the operated femur. Results: The mean Harris Hip Score was 84. All patients had good to excellent function except for 7 who were reported as being non ambulatory. Radiographic evidence of fracture consolidation was found in all cases. Conclusion: The results of intramedullary nailing of intertrochanteric fractures with the use of a short g-nail were very good at a minimum of 5 years. Our data suggest that surgical treatment of pertrochanteric fractures with this kind of fixation is secure.

Infection prevention in practice, Sep 1, 2022

Orthopaedic Proceedings, Mar 1, 2004

Aims: The purpose of this study is to investigate whether the expression of MMP-9 (matrix metallo... more Aims: The purpose of this study is to investigate whether the expression of MMP-9 (matrix metalloproteinase-9) is a potentially useful marker in osteosarcomas. Methods: 55 patients with stage IIB knee osteosarcomas were treated in our unit and had a median follow-up of 68 months. In addition to clinical data, MMP-1, MMP,-2, MMP-3, MMP-7, MMP-9 and MMP-13 were studied in the resection specimens, using immunohistochemical methods. The importance of all factors was studied using the log-rank test, and the overall survival of patients was calculated using Kaplan-Meier survival curves. Multiple variable analysis was carried out using Cox regression models with variables chosen forward and backward stepwise methods with deviance statistics. Signiþcance was set at p Results: On multiple variable analysis only the MMP-9 status of the tumour cells had a signiþcant effect on overall (p=0.032) and disease free survival (p=0.014). Conclusions: Our study shows that some post-chemotherapy osteosarcoma specimens express MMP-9 in the surviving tumour cells after chemotherapy. We believe that MMP-9 in the osteosarcoma cells which survive chemotherapy, contributes to recurrence because of the ability of these cells, to stimulate a new vascular network. The relationship between osteosarcomas and MMP-9 is worthy of further study.

Cancer treatment and research communications, 2022

Journal of Arthroplasty, Jun 1, 2004

We report the use of contained impacted morsellized allograft to revise an aseptically loose, mas... more We report the use of contained impacted morsellized allograft to revise an aseptically loose, massive distal femoral cemented endoprosthetic replacement in a 27-year-old caucasian woman. The prosthesis was inserted 4 years earlier, following neoadjuvant chemotherapy and resection of a distal femoral high grade osteosarcoma. Impaction grafting was used to restore bone stock and maintain femoral length. The patient remains disease free with excellent function, at one year after revision with no evidence of loosening and maintenance of bone stock. We believe it is the first time this technique has been used in revision of a distal femoral endoprosthetic replacement.

Cancer Treatment and Research Communications

Infection Prevention in Practice

International Journal of Molecular Sciences

Musculoskeletal sarcomas represent rare heterogenous malignancies of mesenchymal origin that can ... more Musculoskeletal sarcomas represent rare heterogenous malignancies of mesenchymal origin that can be divided in two distinct subtypes, bone and soft tissue sarcomas. Current treatment options combine the surgical excision of local tumors and multidrug chemotherapy to prevent metastatic widespread disease. Due to the grim prognosis that usually accompanies such tumors, researchers have attempted to shed light on the molecular pathways implicated in their pathogenesis in order to develop novel, innovative, personalized therapeutic strategies. Erythropoietin-producing human hepatocellular receptors (EPHs) are tyrosine-kinase transmembrane receptors that, along with their ligands, ephrins, participate in both tumor-suppressive or tumor-promoting signaling pathways in bone and soft tissue sarcomas. The EPH/ephrin axis orchestrates cancerous processes such as cell–cell and cell–substrate adhesion and enhances the remodeling of the intracellular cytoskeleton to stimulate the motility and in...

Our study sets out to show whether vascular endothelial growth factor (VEGF) expression in stage ... more Our study sets out to show whether vascular endothelial growth factor (VEGF) expression in stage 2B osteosarcomas around the knee influences disease-free and overall survival. Fifty-two such patients treated in out unit were identified and followed-up for for a minimum of 92 months. All were treated according to the current MRC protocol and had resection of their tumour. Tissue from their resected tumours was stained for VEGF using immunohistochemical methods and the percentage of tumour cells staining for VEGF was assessed. The relationship between VEGF expression and survival was assessed using the log-rank test and Kaplan-Meier survival curves. At follow-up 32 (62%) patients were dead, all from metastatic disease. Twenty-six (50%) tumours showed expression of VEGF. Statistical analysis showed that patients with tumours with VEGF expression in more than 25% of the cells had significantly shorter overall survival (p=0.019) and disease free intervals (p=0.009). VEGF is peptide which...

Aims: The purpose of this study is to investigate whether the expression of MMP-9 (matrix metallo... more Aims: The purpose of this study is to investigate whether the expression of MMP-9 (matrix metalloproteinase-9) is a potentially useful marker in osteosarcomas. Methods: 55 patients with stage IIB knee osteosarcomas were treated in our unit and had a median follow-up of 68 months. In addition to clinical data, MMP-1, MMP,-2, MMP-3, MMP-7, MMP-9 and MMP-13 were studied in the resection specimens, using immunohistochemical methods. The importance of all factors was studied using the log-rank test, and the overall survival of patients was calculated using Kaplan-Meier survival curves. Multiple variable analysis was carried out using Cox regression models with variables chosen forward and backward stepwise methods with deviance statistics. Signiþcance was set at p Results: On multiple variable analysis only the MMP-9 status of the tumour cells had a signiþcant effect on overall (p=0.032) and disease free survival (p=0.014). Conclusions: Our study shows that some post-chemotherapy osteosa...

Introduction and Aims: The clavicle has several important functions each of which may be affected... more Introduction and Aims: The clavicle has several important functions each of which may be affected after fracture and malunion of the bone. The aim is to establish any association between shortening of the clavicle, following successful conservative management and clinical outcome. Method: 132 patients with history of an acute fracture of the clavicle were reviewed. None of them had previous pathology affecting shoulder function, prior to injury. Men accounted 93 with average age 25.4 years, and women 39 with average age 34.2 years. All underwent conservative management with standard protocols and the fracture was united. The length and relative shortening of the united clavicle were assessed on a standardised posteroanterior chest x-ray. Intra- and Inter-observer reliability of measurements were assessed. Clinical outcome was evaluated with the Constant score. Mean follow-up was 30 months. Results: Clavicular shortening following fracture union was 11.4 mm on average (range 3–25 mm)...

We report the use of contained impacted morsellized allograft to revise an aseptically loose, mas... more We report the use of contained impacted morsellized allograft to revise an aseptically loose, massive distal femoral endoprosthetic replacement in a 27-year old Caucasian lady. The prosthesis was inserted 4 years earlier, following neo-adjuvant chemotherapy and resection of a distal femoral high grade osteosarcoma. Impaction grafting was used to restore bone stock and maintain femoral length. The patient remains disease-free, with excellent function, at two years after revision with no evidence of loosening and maintenance of bone stock. This is the first time this technique has been used in revision of a distal femoral endoprosthetic replacement.

BackgroundOsteosarcoma (OS) is the commonest primary osseous malignant tumor with a high propensi... more BackgroundOsteosarcoma (OS) is the commonest primary osseous malignant tumor with a high propensity to metastasize in lungs. Pulmonary widespread micrometastatic lesions are present in up to 80% of patients at initial diagnosis and they are associated with significantly worse prognosis. Doxycycline (Dox) is a synthetic tetracycline that has been shown to have anti-cancer properties in vitro and in vivo, and inhibit angiogenesis, effects that may prove beneficial for several types of cancer. The aim of the present work was to study how Dox affects OS cells’ growth in vitro and in vivo and OS-driven pulmonary metastasis in vivo. Methods In vitro, the effect of Dox was measured in MG-63 and 143B human OS cells’ viability, apoptosis, and migration. In vivo, highly metastatic143B cells were orthotopically implanted into the tibia of SCID mice and tumor growth as well as pulmonary metastases between Dox treated and untreated, non-amputated and early amputated xenografts were examined. Res...

International Journal of Molecular Sciences, 2021

Soft tissue and bone sarcomas represent a group of aggressive neoplasms often accompanied by dism... more Soft tissue and bone sarcomas represent a group of aggressive neoplasms often accompanied by dismal patient prognosis, especially when distant metastases are present. Moreover, effective treatment can pose a challenge, as recurrences are frequent and almost half of patients present with advanced disease. Researchers have unveiled the molecular abnormalities implicated in sarcomas’ carcinogenesis, paving the way for novel treatment strategies based on each individual tumor’s characteristics. Therefore, the development of new techniques aiding in early disease detection and tumor molecular profiling is imperative. Liquid biopsy refers to the sampling and analysis of patients’ fluids, such as blood, to identify tumor biomarkers, through a variety of methods, including qRT-PCR, qPCR, droplet digital PCR, magnetic microbeads and digital PCR. Assessment of circulating tumor cells (CTCs), circulating free DNA (ctDNA), micro RNAs (miRs), long non-coding RNAs (lncRNAs), exosomes and exosome–...

Background Osteosarcoma is as a very aggressive primary bone tumor, affecting mainly young popula... more Background Osteosarcoma is as a very aggressive primary bone tumor, affecting mainly young populations. Most cases diagnosed have distant macro and micro-metastases at the time of diagnosis. Surgical resection with neoadjuvant and adjuvant therapies improve overall and disease-free survival of patients. Doxycycline, a synthetic tetracycline has been found to act either as an antibiotic drug as well as a chemotherapeutic agent. Its anti-neoplastic role has been proven to be extremely significant in various types of cancer like prostate, intestinal, central neural system cancers and osteosarcoma. Inhibition of metalloproteinases (MMPs) in different stages of tumor expansion is the most well understood mechanism. MMPs are secreted molecules from various normal cells like fibroblasts, leucocytes and vascular smooth muscles but also from cells with high proliferative potential like tumor cells. In osteosarcoma, MMPs have been found to be overexpressed. MMPs help osteosarcoma cells to sur...

Sarcoma, 1998

Patient.We report the case of a 20-year-old caucasian male with an Ewing's sarcoma in the lef... more Patient.We report the case of a 20-year-old caucasian male with an Ewing's sarcoma in the left upper femur. After induction chemotherapy, he underwent resection of the left upper femur and insertion of a cemented proximal femoral replacement. Four years later, he presented with a solitary bone metastasis in the right upper femur. He underwent further chemotherapy followed by resection and endoprosthetic replacement of the other proximal femur. He remains disease free with excellent function almost a year after the second operation.Discussion.We believe this is the first reported case of bilateral proximal femoral endoprostheses.

Orthopaedic Proceedings, Mar 1, 2005

Injury-international Journal of The Care of The Injured, Sep 1, 2011

Journal of Research and Practice on the Musculoskeletal System, Sep 1, 2019

The total annual number for total hip and knee replacement, for patients suffering from osteoarth... more The total annual number for total hip and knee replacement, for patients suffering from osteoarthrosis is about 1.000.000 in the USA 5. About 2.5 million (1.4 million of women and 1.1 million of men) patients submitted for total hip replacement and 4.7 million (3 million of women and 1.7 million of men) for total knee replacement in USA in 2010 6. The prevalence for total joint replacement in USA is 5.26% for hips and 10.38% for knees 6 .

Injury-international Journal of The Care of The Injured, Sep 1, 2011

sustained a pertrochanteric fracture. The mean age of these patients at the time of admission was... more sustained a pertrochanteric fracture. The mean age of these patients at the time of admission was 74 year old. All patients were treated surgically with internal fixation using short cephalocondylic nails. By the time of a standardised follow up visit at least 5 years after the operation, 30 of these patients had died. The remaining 216 patients were evaluated clinically and radiographically, using Harris Hip Score to assess postoperative functionality and standard x-ray check of the operated femur. Results: The mean Harris Hip Score was 84. All patients had good to excellent function except for 7 who were reported as being non ambulatory. Radiographic evidence of fracture consolidation was found in all cases. Conclusion: The results of intramedullary nailing of intertrochanteric fractures with the use of a short g-nail were very good at a minimum of 5 years. Our data suggest that surgical treatment of pertrochanteric fractures with this kind of fixation is secure.

Infection prevention in practice, Sep 1, 2022

Orthopaedic Proceedings, Mar 1, 2004

Aims: The purpose of this study is to investigate whether the expression of MMP-9 (matrix metallo... more Aims: The purpose of this study is to investigate whether the expression of MMP-9 (matrix metalloproteinase-9) is a potentially useful marker in osteosarcomas. Methods: 55 patients with stage IIB knee osteosarcomas were treated in our unit and had a median follow-up of 68 months. In addition to clinical data, MMP-1, MMP,-2, MMP-3, MMP-7, MMP-9 and MMP-13 were studied in the resection specimens, using immunohistochemical methods. The importance of all factors was studied using the log-rank test, and the overall survival of patients was calculated using Kaplan-Meier survival curves. Multiple variable analysis was carried out using Cox regression models with variables chosen forward and backward stepwise methods with deviance statistics. Signiþcance was set at p Results: On multiple variable analysis only the MMP-9 status of the tumour cells had a signiþcant effect on overall (p=0.032) and disease free survival (p=0.014). Conclusions: Our study shows that some post-chemotherapy osteosarcoma specimens express MMP-9 in the surviving tumour cells after chemotherapy. We believe that MMP-9 in the osteosarcoma cells which survive chemotherapy, contributes to recurrence because of the ability of these cells, to stimulate a new vascular network. The relationship between osteosarcomas and MMP-9 is worthy of further study.

Cancer treatment and research communications, 2022

Journal of Arthroplasty, Jun 1, 2004

We report the use of contained impacted morsellized allograft to revise an aseptically loose, mas... more We report the use of contained impacted morsellized allograft to revise an aseptically loose, massive distal femoral cemented endoprosthetic replacement in a 27-year-old caucasian woman. The prosthesis was inserted 4 years earlier, following neoadjuvant chemotherapy and resection of a distal femoral high grade osteosarcoma. Impaction grafting was used to restore bone stock and maintain femoral length. The patient remains disease free with excellent function, at one year after revision with no evidence of loosening and maintenance of bone stock. We believe it is the first time this technique has been used in revision of a distal femoral endoprosthetic replacement.

Cancer Treatment and Research Communications

Infection Prevention in Practice

International Journal of Molecular Sciences

Musculoskeletal sarcomas represent rare heterogenous malignancies of mesenchymal origin that can ... more Musculoskeletal sarcomas represent rare heterogenous malignancies of mesenchymal origin that can be divided in two distinct subtypes, bone and soft tissue sarcomas. Current treatment options combine the surgical excision of local tumors and multidrug chemotherapy to prevent metastatic widespread disease. Due to the grim prognosis that usually accompanies such tumors, researchers have attempted to shed light on the molecular pathways implicated in their pathogenesis in order to develop novel, innovative, personalized therapeutic strategies. Erythropoietin-producing human hepatocellular receptors (EPHs) are tyrosine-kinase transmembrane receptors that, along with their ligands, ephrins, participate in both tumor-suppressive or tumor-promoting signaling pathways in bone and soft tissue sarcomas. The EPH/ephrin axis orchestrates cancerous processes such as cell–cell and cell–substrate adhesion and enhances the remodeling of the intracellular cytoskeleton to stimulate the motility and in...

Our study sets out to show whether vascular endothelial growth factor (VEGF) expression in stage ... more Our study sets out to show whether vascular endothelial growth factor (VEGF) expression in stage 2B osteosarcomas around the knee influences disease-free and overall survival. Fifty-two such patients treated in out unit were identified and followed-up for for a minimum of 92 months. All were treated according to the current MRC protocol and had resection of their tumour. Tissue from their resected tumours was stained for VEGF using immunohistochemical methods and the percentage of tumour cells staining for VEGF was assessed. The relationship between VEGF expression and survival was assessed using the log-rank test and Kaplan-Meier survival curves. At follow-up 32 (62%) patients were dead, all from metastatic disease. Twenty-six (50%) tumours showed expression of VEGF. Statistical analysis showed that patients with tumours with VEGF expression in more than 25% of the cells had significantly shorter overall survival (p=0.019) and disease free intervals (p=0.009). VEGF is peptide which...

Aims: The purpose of this study is to investigate whether the expression of MMP-9 (matrix metallo... more Aims: The purpose of this study is to investigate whether the expression of MMP-9 (matrix metalloproteinase-9) is a potentially useful marker in osteosarcomas. Methods: 55 patients with stage IIB knee osteosarcomas were treated in our unit and had a median follow-up of 68 months. In addition to clinical data, MMP-1, MMP,-2, MMP-3, MMP-7, MMP-9 and MMP-13 were studied in the resection specimens, using immunohistochemical methods. The importance of all factors was studied using the log-rank test, and the overall survival of patients was calculated using Kaplan-Meier survival curves. Multiple variable analysis was carried out using Cox regression models with variables chosen forward and backward stepwise methods with deviance statistics. Signiþcance was set at p Results: On multiple variable analysis only the MMP-9 status of the tumour cells had a signiþcant effect on overall (p=0.032) and disease free survival (p=0.014). Conclusions: Our study shows that some post-chemotherapy osteosa...

Introduction and Aims: The clavicle has several important functions each of which may be affected... more Introduction and Aims: The clavicle has several important functions each of which may be affected after fracture and malunion of the bone. The aim is to establish any association between shortening of the clavicle, following successful conservative management and clinical outcome. Method: 132 patients with history of an acute fracture of the clavicle were reviewed. None of them had previous pathology affecting shoulder function, prior to injury. Men accounted 93 with average age 25.4 years, and women 39 with average age 34.2 years. All underwent conservative management with standard protocols and the fracture was united. The length and relative shortening of the united clavicle were assessed on a standardised posteroanterior chest x-ray. Intra- and Inter-observer reliability of measurements were assessed. Clinical outcome was evaluated with the Constant score. Mean follow-up was 30 months. Results: Clavicular shortening following fracture union was 11.4 mm on average (range 3–25 mm)...

We report the use of contained impacted morsellized allograft to revise an aseptically loose, mas... more We report the use of contained impacted morsellized allograft to revise an aseptically loose, massive distal femoral endoprosthetic replacement in a 27-year old Caucasian lady. The prosthesis was inserted 4 years earlier, following neo-adjuvant chemotherapy and resection of a distal femoral high grade osteosarcoma. Impaction grafting was used to restore bone stock and maintain femoral length. The patient remains disease-free, with excellent function, at two years after revision with no evidence of loosening and maintenance of bone stock. This is the first time this technique has been used in revision of a distal femoral endoprosthetic replacement.

BackgroundOsteosarcoma (OS) is the commonest primary osseous malignant tumor with a high propensi... more BackgroundOsteosarcoma (OS) is the commonest primary osseous malignant tumor with a high propensity to metastasize in lungs. Pulmonary widespread micrometastatic lesions are present in up to 80% of patients at initial diagnosis and they are associated with significantly worse prognosis. Doxycycline (Dox) is a synthetic tetracycline that has been shown to have anti-cancer properties in vitro and in vivo, and inhibit angiogenesis, effects that may prove beneficial for several types of cancer. The aim of the present work was to study how Dox affects OS cells’ growth in vitro and in vivo and OS-driven pulmonary metastasis in vivo. Methods In vitro, the effect of Dox was measured in MG-63 and 143B human OS cells’ viability, apoptosis, and migration. In vivo, highly metastatic143B cells were orthotopically implanted into the tibia of SCID mice and tumor growth as well as pulmonary metastases between Dox treated and untreated, non-amputated and early amputated xenografts were examined. Res...

International Journal of Molecular Sciences, 2021

Soft tissue and bone sarcomas represent a group of aggressive neoplasms often accompanied by dism... more Soft tissue and bone sarcomas represent a group of aggressive neoplasms often accompanied by dismal patient prognosis, especially when distant metastases are present. Moreover, effective treatment can pose a challenge, as recurrences are frequent and almost half of patients present with advanced disease. Researchers have unveiled the molecular abnormalities implicated in sarcomas’ carcinogenesis, paving the way for novel treatment strategies based on each individual tumor’s characteristics. Therefore, the development of new techniques aiding in early disease detection and tumor molecular profiling is imperative. Liquid biopsy refers to the sampling and analysis of patients’ fluids, such as blood, to identify tumor biomarkers, through a variety of methods, including qRT-PCR, qPCR, droplet digital PCR, magnetic microbeads and digital PCR. Assessment of circulating tumor cells (CTCs), circulating free DNA (ctDNA), micro RNAs (miRs), long non-coding RNAs (lncRNAs), exosomes and exosome–...

Background Osteosarcoma is as a very aggressive primary bone tumor, affecting mainly young popula... more Background Osteosarcoma is as a very aggressive primary bone tumor, affecting mainly young populations. Most cases diagnosed have distant macro and micro-metastases at the time of diagnosis. Surgical resection with neoadjuvant and adjuvant therapies improve overall and disease-free survival of patients. Doxycycline, a synthetic tetracycline has been found to act either as an antibiotic drug as well as a chemotherapeutic agent. Its anti-neoplastic role has been proven to be extremely significant in various types of cancer like prostate, intestinal, central neural system cancers and osteosarcoma. Inhibition of metalloproteinases (MMPs) in different stages of tumor expansion is the most well understood mechanism. MMPs are secreted molecules from various normal cells like fibroblasts, leucocytes and vascular smooth muscles but also from cells with high proliferative potential like tumor cells. In osteosarcoma, MMPs have been found to be overexpressed. MMPs help osteosarcoma cells to sur...

Sarcoma, 1998

Patient.We report the case of a 20-year-old caucasian male with an Ewing's sarcoma in the lef... more Patient.We report the case of a 20-year-old caucasian male with an Ewing's sarcoma in the left upper femur. After induction chemotherapy, he underwent resection of the left upper femur and insertion of a cemented proximal femoral replacement. Four years later, he presented with a solitary bone metastasis in the right upper femur. He underwent further chemotherapy followed by resection and endoprosthetic replacement of the other proximal femur. He remains disease free with excellent function almost a year after the second operation.Discussion.We believe this is the first reported case of bilateral proximal femoral endoprostheses.