Filamentous fungi and filamentous bacteria (i.e., the streptomycetes) belong to different kingdoms that diverged early in evolution. Yet, they adopted similar lifestyles. After a submerged feeding mycelium has been established, hyphae grow into the air and form aerial structures from which (a)sexual spores can develop. These spores are dispersed and can give rise to a new mycelium. Some of the key processes involved in the formation of aerial hyphae by these microbes appear to be very similar. In both cases molecules that lower the surface tension are secreted into the aqueous environment, thereby enabling hyphae to grow into the air. Aerial hyphae are then covered with a hydrophobic film. In fungi, this film is characterized by a mosaic of parallel rodlets, while similar rodlets have also been observed on aerial structures of filamentous bacteria. Although the erection of aerial hyphae in both filamentous fungi and filamentous bacteria is dependent upon (poly)peptides that are structurally unrelated, they can, at least partially, functionally substitute for each other.

Bacterial Proteins↗

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TCV-116 reduces chronic rejection in a rat heterotopic cardiac transplant model.

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Angiotensin-Converting Enzyme Inhibitors↗

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[Posterior dynamic stabilization as an alternative for dorso-ventral fusion in spinal stenosis with degenerative instability].

AIM: Our retrospective study analyzed the outcome of patients with degenerative lumbar instability with spinal stenosis, who underwent decompression surgery with dorsoventral fusion (Group I) and decompression surgery with posterior dynamic stabilization (Group II). METHOD: For 10 patients in each group intra- and postoperative data were obtained and the functional outcome was evaluated with the "Oswestry Low Back Pain Disability Questionnaire" (OQ) and the "Short Form 36 Health Survey Questionnaire" (SF-36). The average follow up was 14.4 months in Group I, 15.2 months in Group II. RESULTS: In Group I the OQ averaged postoperatively 32 points (preoperatively 46 points), the "Physical Component Summary" (PCS) of SF-36 averaged 34 points (preoperatively 24 points), the "Mental Component Summary" (MCS) averaged 43 points (preoperatively 36). In Group II the values at follow up were as follows: OQ 33 points (preoperatively 54), PCS 34 points (preoperatively 28) and MCS 46 points (preoperatively 36). The average hospitalization was 28.4 days in Group I, 19.3 days in Group II and the average operation time was 218 minutes in Group I, 163 minutes in Group II. CONCLUSION: When compared the functional outcome, the dynamic stabilization seems to be a promising alternative to fusion in patients with degenerative lumbar instability with spinal stenosis.

Aged↗

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[Sagittal alignment and segmental range of motion after total disc replacement of the lumbar spine].

AIM: To evaluate changes in static and dynamic values, X-rays of patients who underwent total disc replacement for degenerative disc disease were analyzed. METHOD: An analysis of pre- and postoperative lateral X-rays in 22 patients with 24 total disc replacements (Prodics, Spine Solutions) was performed. The total lumbar lordosis, the segmental lordosis angle, the disc height and the range of motion in the operated level were measured. RESULTS: Postoperatively a significant increase was observed for the following parameters: the anterior (pre: 9.0 +/- 3.4 mm; post: 16.7 +/- 2.4 mm; p < 0.001) and posterior (pre: 4.4 +/- 1.3 mm; post: 8.8 +/- 1.3 mm; p < 0.001) disc height and the segmental lordosis angle (pre: 20 degrees +/- 7.2 degrees; post: 27.7 degrees +/- 7.4 degrees; p < 0.001). Statistically no significant changes could be observed postoperatively for the total lumbar lordosis (pre: 56.2 degrees +/- 10.7 degrees; post: 58.6 degrees +/- 9.3 degrees; p = 0.196) and the range of motion (pre: 5.0 degrees +/- 4.0 degrees; post: 5.9 degrees +/- 3.5 degrees; p = 0.293). CONCLUSION: Total disc replacement for degenerative disc disease of the lumbar spine with the current concept does not alter the range of motion but significantly increases the disc height. The significant increase in segmental lordosis without a change in the total lumbar lordosis accounts for a change in lordosis in adjacent segments.

Adult↗

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[Vertebral body replacement with expandable titanium cages].

OBJECTIVES: The aim of vertebral body replacement is the stabilisation and restoration of the anterior column of the spine with removal of the diseased region. We present our results of stabilisation, pain reduction and neurological improvement using vertebral-body replacement systems METHODS: Between April 1997 and December 2002, 53 patients with malignant vertebral destruction or instability due to traumatic and osteoporotic fracture were treated. We evaluated the results after vertebrectomy and vertebral body replacement by using expandable titanium cages in a retrospective study. RESULTS: The average follow-up time was 18.9 +/- 19.9 months. The mean operation time was 173.2 +/- 77.4 minutes. Intraoperatively, we saw no implant-related complications. Perioperatively, complications appeared in 18 patients (34.0 %). 4 of them were severe, with 2 patients dying. In the total follow-up, 16 patients died, 10 of them (62.5 %) due to tumour progression. Pain reduction was reported in 52.7 %, neurological improvement in 48.0 %. One patient had a loosening of his posterior instrumentation in the further follow-up due to tumour growth with dislocation of the cage and a deterioration of his neurological deficit. CONCLUSION: By using vertebral body replacement systems, sufficient stabilisation of the vertebral column, pain reduction and neurological improvement can be achieved with an acceptable perioperative risk.

Bone Plates↗

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[Prognosis, surgical therapy and progression in cervical and upper-thoracic tumor osteolysis].

INTRODUCTION: This study analyzes the early and mid-term results of our modular rod-screw implant system for the posterior instrumentation of the occipito-cervical, cervical and cervico-thoracic spine (neon occipito-cervical system, Ulrich, Germany) in patients with tumor osteolysis. The prognosis of the patients was evaluated using the Tokuhashi score. METHODS: The cervical and upper thoracic spines of 14 patients (7 males, 7 females, mean age 61 years, range 40-77 years) with osteolysis due to plasmocytoma (n = 2), bronchial (n = 3), mamma (n = 4), thyroid (n = 2), esophageal (n = 1) and pancreatic (n = 1) carcinomas as well as melanoma (n = 1) were instrumentated between June 2001 and April 2004. RESULTS: A stable fixation without loosening or failure of the fixator system was achieved in all cases. No impairment of the neurological status was observed. In our cohort different prognosis scores failed to make a reliable estimate of the expected survival at the time of surgery. CONCLUSION: Posterior instrumentation of the cervical spine including the occipito-cervical and the cervico-thoracic regions with a modular angle-stable rod-screw implant system (neon) offers good stabilization and allows simultaneous decompression. Since tumor masses are predominantly located in the anterior portion of the spine, blood loss can be controlled well. In this patient collective appears difficult to estimate the time of survival by a scoring system.

Adult↗

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[Surgical treatment and prognosis factors in spinal metastases of breast cancer].

AIM: The aim of this study was the evaluation of surgical therapy results and prognosis factors in patients with spinal metastases of breast cancer. METHODS: 55 patients with spinal metastases of breast cancer who were treated surgically were retrospectively evaluated. In 11 patients the cervical, in 27 patients the thoracic and in 17 patients the lumbar spine was affected. RESULTS: Postoperatively, 45 patients (81.8 %) described a reduction in pain and 5 patients (50 %) reported a neurological improvement. Perioperative complications appeared in 27 patients (49.1 %), 2 patients died. For the entire group, the mean postoperative survival was 27.2 +/- 28.6 months and the median survival 16.2 months. In patients with solitary metastasis the univariate analysis did not show a significantly longer postoperative survival than in patients with additional visceral metastases (p = 0.0659), but patients with solitary metastasis showed a significantly longer survival than those with multiple osseous and/or visceral metastases (p = 0.0325). In the univariate analysis, the classification of the primary tumour, the duration of symptoms, the localisation of the metastases, the patient's age and the kind of surgical procedure (posterior stabilising instrumentation versus combined posterior-anterior treatment with intralesional resection of the affected vertebra and vertebral body replacement) did not show a significant influence on the postoperative survival. The multivariate analysis did not show a significant prognostic influence for the potentially prognostic factors, however, solitary and multiple metastasis showed the highest statistical influence for the prognosis (p = 0.1187), followed by the classification of the primary tumour (p = 0.1243). CONCLUSION: Pain reduction and neurological improvement can be reached by a stabilisation of the diseased spinal region. Patients with spinal metastases due to breast cancer showed a relatively long postoperative median and mean survival. Therefore, the preoperative evaluation of extent of the disease and the therapy concept should be individually adapted. The surgical procedure (posterior stabilising instrumentation versus combined posterior-anterior approach with vertebrectomy and vertebral body replacement) does not significantly influence the survival.

Adult↗

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[Diagnosis and therapy of spinal stenosis in the elderly].

PROBLEM: Spinal stenosis is a common and increasing problem in the elderly population and a diagnostic and therapeutic challenge. METHODS: An overview of etiology, epidemiology, diagnostics and therapy is given based on a literature review of the years 1978-1998 and experiences since 1985. RESULTS: Dealing with spinal stenosis we have to distinguish concerning diagnostics and therapy between cervical and lumbar spinal stenosis. The cardinal symptom of the lumbar spinal stenosis is the claudicatio spinalis and of the cervical spinal stenosis the cervical myelopathy occasionally combined with radiculopathy. The first therapeutic step should be the conservative therapy in nearly all cases, the only exception is a severe cervical myelopathy where an operation is indicated. In case of persistent or progressive symptoms under a sufficient conservative therapy, operative therapy is indicated. The different possible therapy decisions will be based on flow-charts. CONCLUSION: Whereas in lumbar spinal stenosis the indication for operative therapy should be considered with reservation, in cervical spinal stenosis with myelopathy operative therapy should be considered at an early stage.

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