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Biomedical subjects

G Delling

Publications and source records attributed to G Delling.

At least 289 records · Page 16Linked to original sources
PubMedDate not supplied

Relation between 2- and 3-dimensional architecture of trabecular bone in the human spine.

By means of a new preparation technique which allows the combined 2- and 3-dimensional analysis of trabecular bone we analyzed the vertebral bodies of 22 autopsy cases. None of these cases had any skeletal disease. With increasing age bone volume was decreased in all vertebral bodies (2nd cervical to 5th lumbar body) but this decrease was more pronounced in the lower vertebrae. In the upper cervical spine there was nearly no age-related loss of trabecular bone volume. 3-D analysis demonstrated that the loss of bone tissue is due to a loss of trabecular plates which are transformed to trabecular rods by perforations. The number of plates and rods could be measured directly. In the 2nd lumbar vertebra at the age of 20 years the density of plates was 0.61 mm, the density of rods was 0.2/mm. At the age of 80 years the density of plates was 0.2/mm. The density of rods remained constant at all ages. Perforations could be seen directly. They were located mainly in trabecular plates. At higher ages they occurred in rods either. The number of vertically oriented trabeculae was about twice the number of horizontal ones. The rate of age-dependent reduction of trabeculae was the same in horizontal and vertical trabeculae. It was possible to do real 3-dimensional measurements of the diameter of trabecular rods. These values were compared to the calculated values of trabecular plates. In mean trabecular plates are thinner than rods. It could be demonstrated that microcallus formation is a common feature in the human spine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Tumors of the footbones- a report from the Hamburg Bone Tumor Registry].

Aim of the present study was a systematic examination of the tumors of the foot registered in the Hamburg Bone Tumor Registry regarding age, sex, location, diagnosis and morphological characteristics. The registry files and histological specimens of 367 tumors and tumor-like lesions of the foot were reviewed. Males were more frequently affected (ratio 4 : 3). Some 20.4 % of all mass forming tumors were malignant. Cartilage tumors (146 cases), cystic (132 cases) and osteoblastic lesions (33 cases) were most common. Several tumors showed a strong predilection for certain parts of the foot. In the calcaneus a solitary bone cyst was the most common lesion. Lesions in the talus and metatarsals with a similar morphology mostly represented intraosseous ganglion cysts. Other tumors in the calcaneus were mainly cartilaginous. Besides chondroblastoma, chondrosarcoma was regularly diagnosed. Chondroma was extremely rare at this site. Contrary to that chondroma was regularly found at the metatarsal and phalangeal bones, it was 4 times more common than chondrosarcoma. An even distribution showed aneurysmal bone cysts and osteoidosteoma. Very rare lesions were fibrous dysplasia, eosinophilic granuloma and intraosseous lipoma. The knowledge of the distribution of tumors in the foot is important for an exact differential diagnosis and thereby for biopsy planning, diagnosis and therapy.

Adult↗
PubMedDate not supplied

[Calcaneal cyst: a classical simple bone cyst?].

INTRODUCTION: In the calcaneus differentiation between a solitary cyst and intraosseus lipoma is difficult. Radiologists frequently diagnose an intraosseus lipoma, whereas histology shows the classical signs of a solitary bone cyst. We present 12 cases of a solitary cyst of the calcaneus. MATERIAL AND METHODS: Between 1993 and 2001 we operated on 12 patients (8 men, 4 women, median age 28 +/- 14 years) with calcaneal cysts. 9 patients received a curretage and an autologous, one patient a homologous, one patient a mixed autologous-homologous bone-grafting and one patient only a curretage (due to the small diameter of the cyst) of their cysts. RESULTS: No case revealed the histological picture of a fatty formation, which appears to be typical for an intraosseus lipoma. All of the microscopic findings resembled the characteristics seen in cysts of the long bones. A pathological fracture has not been observed. CONCLUSION: The histologically confirmed calcaneal cysts showed the radiological signs that are supposed to be typical for an intraosseous lipoma. It cannot be decided whether the histologically diagnosed calcaneal lipomas described by others can be interpreted as fatty degeneration of a calcaneal cyst, or whether fatty areas of the bone marrow have given a wrong impression. Since the literature only describes single isolated cases of a pathological fracture of the calcaneal cyst or lipoma, asymptomatic patients should be treated non-operatively.

Adolescent↗
PubMedDate not supplied

[Neoadjuvant chemotherapy of osteosarcoma. Preliminary results of the cooperative COSS-86 osteosarcoma study].

The neoadjuvant study COSS-86 was undertaken aiming at (1) improving the cure rate in osteosarcoma by early intensification of chemotherapy in high risk patients and (2) investigating the effect of intraarterial (i.a.) versus intravenous (i.v.) administration of cisplatinum. (1) Ifosfamide was added to the well proven drugs in osteosarcoma such as doxorubicin, high-dose methotrexate and cisplatinum in patients with large tumor size or/and high portion of chondroid groundsubstance or/and scintigraphic nonresponse after 4 weeks of preoperative chemotherapy. It was given in combination with cisplatinum. (2) The same patients were allocated to either the intraarterial study arm or the intravenous control arm of the study. The response rate (greater than 90% tumor necrosis) of all patients was 75% (88/118). No advantage in response rate was achieved by i.a. infusion of cis-platinum within this highly efficient 4-drug regimen (i.a. 75% (33/44) vs. i.v. 74% (35/47)). The significantly improved response rate in this study results in a better metastasis free survival (MFS) of 77% (+/- 4) at 4 years.

Adolescent↗
PubMedDate not supplied

[Neoadjuvant chemotherapy of osteosarcoma. Results of the cooperative studies COSS-80 and COSS-82 after 7 and 5 years].

The analysis of the results of two German Pediatric Oncology (GPO) cooperative, neoadjuvant chemotherapy trials after a followup of 7 (COSS-80) and 5 years (COSS-82) allows several conclusions concerning both systemic and local treatment of patients suffering from osteosarcoma. A metastasis free survival rate (MFS) of 59% was reached in the reduced study group of the first study, COSS-80. In addition to size of the primary tumor, the extent of chemotherapy induced devitalisation was very closely related to the probability of survival without systemic recurrence. Following this observation, it was the aim of the next study, COSS-82, to improve the MFS of patients with poorly responding tumors by altering their postoperative chemotherapy regimen. However, this "salvage" approach failed. Moreover, an effort to reduce treatment related toxicity by sparing some patients from the side effects of two particularly toxic drugs, adriamycin (ADR) and cisplatinum (CDDP), by only giving these postoperatively and only after insufficient tumor response to preoperative therapy, failed (MFS of the study arm of COSS-82 45% at 5 years vs. 68% for the control arm with primary use of ADR and CDDP, p less than 0.05). The value of an effective primary chemotherapy is further enhanced by the observation, that en bloc resection of tumors which were poor responders to preoperative therapy was associated with an increased risk of distant metastases when compared with amputation and rotation plasty, while this was not the case for good responders. In conclusion, both systemic tumor control and optimal local therapy require that all effects drugs are to be used as early as possible in the primary treatment of osteosarcoma, in order to enforce maximum tumor cell destruction and hence an optimistic outlook for the individual patient.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[Nuclear medicine prediction of histologic tumor response of osteosarcoma].

The prediction of histologic tumor response to preoperative chemotherapy was assessed by quantitative scintigraphic follow-up examinations of 54 osteosarcomas. Tumor/non-tumor scintimetry using 99mTc labeled diphosphonates allowed accurate prediction of tumor response in 28 of 30 tumors (accuracy = 93%) after completion and in 10 of 12 osteosarcomas (accuracy = 83%) at the half-way stage of preoperative chemotherapy evaluating only those tumors which showed convergent changes of tumor/non-tumor ratios in the perfusion and the mineral phase. At the half-way stage, however, evaluation of chemotherapy effects was complicated in 12 of 23 osteosarcomas by diverging T/NT ratios. In contrast, quantification and mapping of the tumor plasma volume and 99mTc MDP plasma clearance predicted the histologic tumor response to chemotherapy in 12 of 13 tumors (accuracy = 92%) after completion and in all 11 cases (accuracy = 100%) at the half-way stage.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[Pathomorphology of malignant chondrogenic bone tumors--an analysis of 94 cases from the Hamburg Bone Tumor Register (1974-1989)].

89 central and 5 periosteal chondrosarcomas identified between 1974-1989 were reviewed in a retrospective study. The purpose of this study was to examine the morphological characteristics of different types of chondrosarcomas and to describe remarkable features of location, age distribution and male to female ratio. We distinguish four types of centrally located chondrosarcoma: classical chondrosarcomas, dedifferentiated chondrosarcomas, mesenchymal chondrosarcomas and clear cell chondrosarcomas. Five periosteal chondrosarcomas were represented. Classical chondrosarcomas as well as clear cell chondrosarcomas indicate a significant predominance of males; no sex predilection in dedifferentiated and mesenchymal chondrosarcomas was seen. Nearly 60% of classical and mesenchymal chondrosarcomas occur in the trunk. 85% of dedifferentiated chondrosarcomas are located in the long bones of the limbs. The most common location of clear cell chondrosarcoma is the proximal part of the femur. There is a marked predilection for mesenchymal chondrosarcomas in the second and third decades of life. The mean age of patients with classical chondrosarcomas was 54 years, but clear cell chondrosarcomas occur 10 years earlier and dedifferentiated chondrosarcomas 10 years later. Characteristically, classical chondrosarcomas produce a pure chondroid matrix with variable differentiation of tumour chondrocytes. The most important histological feature of the dedifferentiated chondrosarcoma is the close association of two different cellular components. One of these consists of cartilage, which is generally well differentiated. In most of our cases the second component showed features of osteosarcoma (50%). Mesenchymal chondrosarcoma is characterized by concentric infiltration of cartilage islands by small tumour cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Stimulation of osteoblasts in skeletal metastases--a quantitative study].

In almost 80% of all skeletal metastases of carcinoma of the prostate, osteoneogenesis by "normal" osteoblasts can be detected in the surrounding tissue. The object of the present study was to perform a quantitative histomorphometric analysis of this local osteoblast stimulation. In tissue with metastases, the relative proportion of osteoid and mineralized bone tissue per unit of volume (Vv = 46%) was three times higher than the norm (Vv = 15%). Although the lamellar spongiosa (Pm = 19%) was only slightly higher than the physiological values (Pm = 15%), a considerable increase in fibrous bone tissue (PFK = 39%) was found (normal value: 1-2%). The volumetric density of the osteoid (POST = 7%) had also increased (normal value: 7%). While the mean width of the trabecula of the lamellar spongiosa was within normal range (dTRAB/LK = 136 microns), appositional accumulation of a 62 microns thick fibrous bone layer resulted in a distinct tumefaction of the trabeculae. The width of the osteoid border (dapp.OST) was 22 microns (normal value: 13 microns). The majority of the activated osteoblasts were 30-150 microns from the neighboring tumor cells.

Bone Neoplasms↗
PubMedDate not supplied

[Morphologic study of iliac crest spongiosa in patients with osteoporosis treated according to the ADFR (activation, depression of resorption, formation, repeat the cycle) with parathyroid hormone and diphosphonates (Hannover PTH I study)].

Treatment of osteoporosis with a complete reconstruction of the normal three dimensional architecture of trabecular bone is an unsolved problem. In addition to the well established fluoride therapy new concepts in the treatment of osteoporosis were developed. There is growing interest in the so called ADFR concept (activation, depression of resorption, formation, repeat the cycle) as a physiological stimulation of osteoblastic bone formation. The histological results following ADFR treatment in 8 patients are reported. After 12 months of treatment with parathyroid hormone [1-38)hPTH) (stimulation of the basic metabolic units) and the diphosphonate EHDP (depression of osteoclastic resorption) no change of remodelling processes at the trabecular bone surface could be observed. The results demonstrate many doubts in the importance of the ADFR concept for the treatment of osteoporosis.

Adult↗
PubMedDate not supplied

[Clear cell chondrosarcoma--clinico-pathological report of an additional case].

On account of the rarity and its histologic features, the clear-cell chondrosarcoma is a particular entity. Up to the present, 98 cases have been reported in the literature. In the present report one case located in the proximal femur will be discussed. Approximately 60% of these tumors are situated in the mentioned region. Including one referred case, which will not be described in detail, 100 cases have been recognized. Clear-cell chondrosarcoma is radiographically indistinguishable from benign lesions or chondroblastoma. Therefore the histologic examination is crucial for the diagnosis. The histologic characteristics preclude the diagnosis of chondroblastoma. Clear-cell chondrosarcoma is characterized by regions of chondroid matrix and areas of closely packed, glycogen-rich large tumor cells with distinct boundaries. The centrally located nuclei are large with marked polymorphism, surrounded by abundant clear PAS positive cytoplasm. The chondroid matrix is lacking. Osteoid formation and multinucleated giant cells are present in clear-cell areas. In spite of the low malignancy there is still a metastatic potential. Therefore the type of surgical treatment is very important. En bloc excision with wide margins is the treatment of choice. The knowledge about this tumor is crucial for adequate surgical therapy.

Adult↗
PubMedDate not supplied

[Neoadjuvant therapy for localized osteosarcoma of extremities. Results from the Cooperative osteosarcoma study group COSS of 925 patients].

BACKGROUND: Owing to twenty years of multicentric interdisciplinary cooperation, the COSS group has been able to collect data on a large group of osteosarcoma patients treated by neoadjuvant therapy. This paper reviews results achieved in patients with localized extremity tumors. PATIENTS AND METHODS INCLUSION CRITERIA: Registration into a completed neoadjuvant COSS-Study. Histologically confirmed, primary, localized, high-grade, central osteosarcoma of an extremity; age < 40 years; no pretreatment; interval diagnosis to chemotherapy < or = 3 weeks; no severe comorbidity. Chemotherapy: HD-methotrexate +/- doxorubicin +/- cisplatin +/- ifosfamide +/- BCD. Scheduled local therapy: Surgery. RESULTS: 925 evaluable patients from 101 institutions. Median age 15 years, m:f 1.4:1. Primary site: femur 510, tibia 251, humerus 100, fibula 51, other 13. Tumor-size < 1/3 of the involved bone 616, > or = 1/3 304. Definitive surgery in 903/925 cases, 443 limb salvage procedures. Good response (> 90% necrosis) in 469/806 (58.2%) evaluated tumors. Median follow-up for surviving patients: 5.42 years. Actuarial survival after 5 and 10 years: 72.5% (95%-CI 69.3-75.7) and 66.3% (62.5-70.0), relapse-free 62.1% (58.7-65.4) and 59.4% (55.8-63.0). 683/925 alive (601 first remission), 242 deceased (212 tumor progression, 30 other causes). 66.2% (97.3%) of all relapses within 2 (5) years. Prognosis correlates with tumor-size (< vs. > or = 1/3: 69.9% vs. 58.3% at 10 years) and -site (tibia: 74.2%, humerus: 54.5%) and -response (good vs. poor: 78.2% vs. 52.5%) (all p < 0.01). Actuarial 10-year survival by response grading I-VI according to Salzer-Kuntschik 80.9%, 82.8%, 71.1%, 60.7%, 47.7%, 27.3%. COSS-studies with preoperative 4-drug therapy more efficacious than less aggressive protocols. No impact of doxorubicin scheduling (sequential: rapid vs. 48 h-continuous infusion) or cisplatin scheduling (randomized: 5 h vs. 72 h-infusion) on prognosis detected. CONCLUSIONS: Intensive multiagent chemotherapy and delayed surgery for localized extremity osteosarcoma led to excellent oncologic results in the COSS-studies. Tumor-size, -site, and -response as well as the intensity of upfront chemotherapy correlated with outcome. Giving doxorubicin and cisplatin by continuous infusions did not result in discernible prognostic disadvantages.

Adolescent↗
PubMedDate not supplied

[Bone and boundary zone changes following the implantation of double-cup arthroplasties].

21 femoral heads of 20 patients with double cup arthroplasty were examined after an implantation period of 1 to 5 years, in one case after 18 years. In 8 cases the hipe socket and in 10 cases the femoral cup became loose. Therefore an operative removal was necessary. 2 patients showed extensive periarticular ossifications. In connection with the metal cup the resected femoral heads were cut in slices of 1 cm. thickness. After taking an X-ray they were embedded without decalcification in methylmetacrylate. The sections were stained with different methods (Goldner, v. Kossa modification). In the group with fixed cup a local osteoporosis is dominating. The fibrous tissue membrane between cement and bone tissue is varying in thickness. It is thicker at the periphery of the cup. In the group with loosened cups large irreparable bone necrosis with included histiocytic granulomas, could be observed. The clinical problems are discussed in accordance to the long term prognosis on the basis of the morphological results.

Acetabulum↗
PubMedDate not supplied

Studies of the RB1 gene and the p53 gene in human osteosarcomas.

We analyzed 14 native osteosarcoma tissue samples for alterations of the tumor suppressor genes RB1 and p53 on the DNA level, and as far as possible, the RNA level. Southern blot analyses concerning both tumor suppressor genes were carried out in all osteosarcomas. In two cases we could demonstrate a deletion within the RB1 gene. DNA analysis of a third osteosarcoma patient revealed a rearrangement of the p53 gene. We had the opportunity of performing corresponding northern analyses in eight native osteosarcoma specimens. The RB1 gene expression was significantly decreased or completely absent in six tumor samples. In two of these tissue probes the expression of both tumor suppressor genes was missing. We determined coexistence of decreased expression of both tumor suppressor genes in one additional case. In summary, 7/14 or 6/8 cases of osteosarcomas (including only those cases which allowed both analyses) showed RB1 gene alteration. In 3/14 or 3/8 osteosarcomas we could determine p53 gene abnormalities. This may indicate that either loss of p53 function is etiologically important only for the development of some osteosarcomas, or a major part of p53 gene mutations are subtle ones and their detection requires more sophisticated techniques, which are currently under development.

Bone Neoplasms↗
PubMedDate not supplied

SV40 sequences in human osteosarcoma of German origin.

Simian virus 40 (SV40) is a dsDNA polyomavirus that induces osteosarcomas and mesotheliomas in hamsters and transforms many types of cells in tissue culture, including human cells. Osteosarcoma is a bone malignancy with multiple molecular lesions underlining progression from normal bone to osteosarcoma. Recent investigations have identified SV40 DNA sequences in osteosarcomas, suggesting that SV40 may contribute to tumor development. However, these studies also demonstrated that geographical differences exist between SV40 and tumor association. Our study analyzed 46 frozen German tumor specimens (42 osteosarcomas and 4 sarcomas initially suspected to be osteosarcomas) for the presence of SV40 DNA sequences by using PCR. Two different primer sets amplifying a 573 bp region of SV40 Tag gene with the complete intron sequence (SV.for 2/SV.rev) and a 172 bp region with no intron sequence (SV.5/SV.6) were used. DNA sequencing analysis verified the results. No SV40 sequences could be detected using the primer set SV.for 2/SV.rev, while 2 out of 42 osteosarcoma specimens and 1 out of 4 poorly-differentiated tumor specimens contained SV40 sequences, using the primer set SV.5/SV.6. From one of these two positive osteosarcomas, multiple tumor biopsies taken at different times during the dissection, including metastasis, tested positive for SV40. These results indicated that in Germany, only rare osteosarcomas can be linked to SV40. These results support previous findings involving geographical differences in the presence of SV40. Finally, the specific detection of SV40 sequences with multiple specimens from one of the two patients and the absence of SV40 sequences in all other samples underscores the specificity and reproducibility of this investigation and ruled out PCR contamination.

Adolescent↗
PubMedDate not supplied

[Is transient hip osteoporosis a transient osteonecrosis?].

A patient suffering from transient osteoporosis of the hip sustained a fracture of the ipsilateral collum femoris. Total hip replacement was performed. The complete specimen of the proximal femur was subjected to histological examination. The histological findings were consistent with the reparation stage of ischaemic bone necrosis of the femoral head. The authors discuss whether transient osteoporosis of the hip is a transient, i.e. self-recovering ischaemic necrosis of the femoral head.

Diagnosis, Differential↗