PURPOSE: While the rare Seckel-Syndrome is defined by clear criteria, clinical and radiologic findings for microcephalic osteodysplastic primordial dwarfism (MOPD) make an exact diagnosis and classification difficult. By comparing our patients to previously described cases of MOPD we evaluate the hypothesis that this disorder has a greater heterogeneity than has been believed up until now. Furthermore the differential diagnosis of the MOPD-complex is discussed. RESULTS: Two cases that show typical growth retardation, microcephalus and facial anomalies as well as osteodysplastic deformities including hip dysplasia are presented. The parents of both children are consanguineous and of Arabic race. In one of the children growth hormone levels were noticeably decreased. In discrepancy to the Seckel-syndrome both children showed no signs of mental retardation, therefore the classification into the heterogeneous group of microcephalic osteodysplastic primordial dwarfism (MOPD) is the most likely diagnosis. CONCLUSION: It is suggested that microcephalic osteodysplastic primordial dwarfism (MOPD) has a greater clinical and radiological expression than has been assumed up until now. Whether our results are merely a variant or suggest a new subtype of the MOPD can only be resolved by further cases. The exact pathogenesis of the disease currently remains unknown but the most probable cause is an autosomal recessive inheritance.

Abnormalities, Multiple↗

PubMedDate not supplied

[Dorsal lumbar interbody implantation of cages for stabilizing segmental spinal instabilities].

PURPOSE: The technique of posterior lumbar interbody fusion (PLIF) has been critically discussed due to a high degree of complications, including the development of pseudarthrosis. With the recent establishment of intercorporeal implants new aspects have to be contemplated in surgical techniques, especially concerning the posterior approach. In this study we present our first results after intercorporeal stabilisation of segmental spinal instabilities utilising carbon and titanium cages. METHOD: 45 spinal instabilities were surgically stabilised in 42 patients who were evaluated on average for 2.8 years post-operatively. 12 patients had isthmic and 19 patients degenerative instabilities while 11 patients suffered from instabilities resulting from prior spinal surgery. RESULTS: Assessed according to the Hambly-score, 69% of the patients had an excellent or good result; 2 (4.8%) patients were subjectively worse off than before surgical treatment. After implantation of cages precise radiological evaluation of bony ingrowth is frequently impaired by artefacts. We found that three months after implantation of a titanium cage, which had to be removed after incorrect placement, no bony consolidation was visible. Persisting or recurrent instabilities in fused segments were not recorded. CONCLUSION: By means of PLIF and implantation of cages the interbody space is reconstructed and jeopardized neural structures are decompressed. In addition to this, the frequently osteochondrotically degenerated segment is immobilized. The posterior approach allows decompression of neural structures and, with comparable results concerning stability, the considerable risks of the ventral approach are avoided.

Adult↗

PubMedDate not supplied

[Comparison of dorso-lateral and dorso-ventral stabilization procedures in the treatment of vertebral fractures].

AIM: The radiological and clinical outcome of surgical treated thoracolumbal fractures were followed up after 6.7 years. METHOD: The study encompassed 97 patients. The degrees of the bony deformation and the local kyphosis were measured on the lateral view X-ray at 4 different time points: post trauma, after the operation, before implant removal and at the follow up examination. The clinical outcome was evaluated by the Oswestry score. RESULTS: 74 fractures were treated with a fixateur intern and a dorsal fusion by apposition of autologous bone postero-laterally. 23 fractures were fused in a combined dorso-ventral manner by intervertebral fusion with tricortical autologous bone. The lateral X-rays showed a loss of correction up to 48 % in the dorsal fused group and 10 % loss of correction in the combined group. The local kyphosis increased up to 84 % in the dorsal operated group due to degeneration of the injured disk. The clinical Oswestry score showed no significant difference in both groups. CONCLUSION: The additional ventral surgery should be evaluated carefully.

Adult↗

PubMedDate not supplied

[The mechanical effects of shock waves in extracorporeal shock wave treatment of calcific tendinitis--an in vitro model].

OBJECTIVE: Various studies have shown the benefit of the extracorporal shock wave therapy in the treatment of the calcific tendinitis. It was the aim of this study to examine the energy needed to disintegrate a calcific deposit. METHOD: By using the in vitro model of the pig shoulder the mechanical effects of different energy levels and impulse rates on the calcifying deposits are investigated. RESULTS: The results are showing the energy- and impulse-depending effect of the shockwaves. The disintegration of the implanted "bonn-stones" with development of an large amount of fragments smaller then 1000 microns requires an energy of 0.42 mJ/mm2 and between 2000 and 3000 impulses. CONCLUSIONS: According to the experimental results a instant mechanical effect on the calcifying deposits using the ordinary parameter is unlikely. The absorption of the calcifying deposits in likely induced through cellular clearing function. Clinical trials confirmed the good therapeutical results after two sessions with at least 1500 pulses and an energy of 0.28-0.30 mJ/mm2.

Animals↗

PubMedDate not supplied

["Primary" shoulder stiffness: illness duration and therapeutic comparison].

AIMS: Etiology, natural history and therapy of the frozen shoulder still remains obscure. Therefore observation of natural history is of interest. METHOD: In a retrospective study 140 patients with different therapies were followed-up. RESULTS: 28 (20%) patients were not considered as healed because of persisting complaints during the whole follow-up period with an average duration of 49 months. Mobilisation under anaesthesia (27 patients) showed an less improval in range of motion with a shortening of complaint period. CONCLUSION: The existence of a subgroup of patients with no response on regular therapy is assumed.

Adult↗

PubMedDate not supplied

[Short-term results (2-5 years) of type Furlong hydroxyapatite-coated hip endoprosthesis].

The short term clinical and radiological results of a hydroxyapatite-coated hip prosthesis with bonding osteogenesis on the hydroxyapatite ceramic and bony tissue reaction had to be studied. 233 patients who had hip replacement were followed up for two to five years and assessed radiologically and by the Merle D'Aubigné rating. Primary total hip arthroplasty as well as revision arthroplasty show sufficient clinical results. Tight pain and aseptic loosening of the stem did not occur. Hydroxyapatite-coating and contour for the Furlong hip prosthesis show a reliable short term anchorage.

Adult↗

PubMedDate not supplied

Emotional memory formation is enhanced across sleep intervals with high amounts of rapid eye movement sleep.

Recent studies indicated a selective activation during rapid eye movement (REM) sleep of the amygdala known to play a decisive role in the processing of emotional stimuli. This study compared memory retention of emotional versus neutral text material over intervals covering either early sleep known to be dominated by nonREM slow wave sleep (SWS) or late sleep, in which REM sleep is dominant. Two groups of men were tested across 3-h periods of early and late sleep (sleep group) or corresponding retention intervals filled with wakefulness (wake group). Sleep was recorded polysomnographically. Cortisol concentrations in saliva were monitored at acquisition and retrieval testing. As expected, the amount of REM sleep was about three times greater during late than during early retention sleep, whereas a reversed pattern was observed for SWS distribution (P < 0.001). Sleep improved retention, compared with the effects of wake intervals (P < 0.02). However, this effect was substantial only in the late night (P < 0.005), during which retention was generally worse than during the early night (P < 0.02). Late sleep particularly enhanced memory for emotional texts. This effect was highly significant in comparison with memory for neutral texts (P < 0.01) and in comparison with memory after late and early wake intervals (P < 0.001). Cortisol concentration differed between early and late retention intervals but not between sleep and wake conditions. Results are consonant with a supportive function of REM sleep predominating late sleep for the formation of emotional memory in humans.

Adult↗

PubMedDate not supplied

Improving first-line therapy of advanced ovarian cancer - the AGO Ovarian Cancer Study Group perspective.

This review displays the AGO Ovarian Cancer Study Group approach towards evaluation of improvement options in first-line therapy of advanced ovarian cancer. Prospectively randomized phase III trials evaluating the addition of newer drugs to standards carboplatin-paclitaxol (TC) as well as pilot trials evaluating new treatment modalities like anti-idiotype CA 125 antibodies or epidermal growth factor receptor (EGFR) modulation are presented.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

Bone metastases in vulvar cancer: a rare metastatic pattern.

Bone metastases from a vulvar carcinoma are exceptionally rare with only five reported cases in the literature. We report on a patient who was initially treated with radical vulvectomy and bilateral inguinal lymphadenectomy for a vulvar cancer (pT2, pN2 (6/37), M0; G2). Due to a positive nodal status, adjuvant radiation of the vulva and the pelvis was performed additionally. The patient presented 4 months after initial therapy with severe pain in the right humeral shaft due to a pathologic fracture based on an osteoclastic metastasis. During osteosynthetic stabilization histologic and immunohistochemical stain gave evidence of a metastasis of the known vulvar carcinoma. Bone scan showed enhancements in both humeral heads as well as the right distal femur, whereas plain radiographs confirmed further metastases in all suspected areas. In conclusion, bone metastases should be considered in the differential diagnoses of unclear osseous pain in women with a history of vulvar cancer. Immunohistochemical examinations might be important to depict the epithelial character of the tissue and allude to the metastatic nature of such rare lesions. The atypical location should alert the physician to suspect distant metastasis, rather than locoregional disease.

Aged↗

PubMedDate not supplied

Fluorescence in situ hybridization for detecting erbB-2 amplification in breast tumor fine needle aspiration biopsies.

OBJECTIVE: To evaluate the feasibility of erbB-2 amplification analysis of fine needle aspiration (FNA) biopsies. STUDY DESIGN: FNA smears and dissociated nuclei from 58 breast cancer samples were examined by dual-labeling fluorescence in situ hybridization (FISH) with probes for centromere 17 and the erbB-2 gene. The results were compared with the outcome of erbB-2 immunohistochemistry. RESULTS: Tumors were categorized according to the erbB-2/centromere 17 signal ratio. There were 23 tumors with high-level amplification, four cases with a low-level erbB-2 gain and 27 tumors with normal erbB-2 content. Four tumors showed an erbB-2 deletion, all in patients < or = 42 years of age. ErbB-2 amplification was strongly associated with positive erbB-2 immunostaining (P < .0001). Comparison of FISH analysis on dissociated cells and on FNA biopsies showed high correspondence (P < .0001). CONCLUSION: FISH allows reliable detection of erbB-2 gene amplification on FNA biopsies.

Adult↗