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Biomedical subjects

W Winkelmann

Publications and source records attributed to W Winkelmann.

At least 253 records · Page 14Linked to original sources
PubMedDate not supplied

[Chronic pain syndromes in orthopedics--typical sites, follow-up and patient characteristics].

This epidemiological questionnaire--study about 362 patients suffering from chronic pain related to muscle skeletal disorders shows the following results: most muscle skeletal pain syndromes are located in the area of the head and back (57.5%), patients who want to be treated in an orthopedic pain ambulance, suffer from at least "moderate" pain according to the verbal rating scale and at least from pain equal or more than 50 according to the numeric rating scale, for most patients (51.9%) the duration of the pain has been between 1 and 10 years, about twice as many women (60.5%) than men (39.5%) suffer from chronic muscle skeletal pain, pain syndromes seem to be of more chronic duration in women than in men, and women tend to take pain killers more frequently than men, most patients with chronic pain consult 2 to 6 doctors, for typical orthopedic pain syndromes most patients consult an orthopedic doctor, patients suffering from chronic headache consult an orthopedic specialist about as frequently as an neurologist or internal specialist.

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

[EICESS 92 (European Intergroup Cooperative Ewing's Sarcoma Study)-- preliminary results].

BACKGROUND: Ewing tumor patients' outcome is 50% to 60% with current treatment strategies. Questions concerning toxicity and secondary malignancies are of increasing importance. PATIENTS AND METHODS: 631 patients were registered with the German EICESS study center of the European Intergroup Cooperative Ewing's Sarcoma Study, 369 patients were randomized. Treatment apart from local therapy consisted of 14 courses of Vincristine, Actinomycin D, Cyclophosphamide or Ifosfamide, Adriamycin (Doxorubicin), with or without Etoposide. First results concerning event-free survival (EFS), toxicity, and the rate of secondary malignancies three years after diagnosis are presented. RESULTS: Three year EFS was 0.66 for patients with localized tumors, 0.43 for patients with primary pulmonary/pleural metastases, and 0.29 for patients with other metastases, respectively. Large tumor volume or pelvic site, especially if inoperable, were adverse prognostic factors. Both histological and MRT-defined response were positively correlated to outcome. Up to 67% of patients experienced WHO grade IV toxicity, mostly related to bone marrow depression. The treatment related mortality was 1% (6/631). Until 15.02.1999, six of 687 patients have suffered secondary malignancies, two of six after (additional) myeloablative therapy. CONCLUSIONS: EICESS 92 treatment is toxic, but manageable and compares favorably to international results. New strategies must be sought for certain risk groups of patients.

Adult↗
PubMedDate not supplied

Assessment of molecular genetic detection of chromosome translocations in the differential diagnosis of pediatric sarcomas.

BACKGROUND: Recent studies have shown that many types of soft-tissue sarcomas are characterized by specific chromosomal translocations, which are likely to be of etiologic significance. In order to evaluate their diagnostic impact, a panel of 129 sarcomas comprising 78 Ewing's tumors (ET), 19 rhabdomyosarcomas (RMS), 20 neuroblastomas (NB), 9 synovialsarcomas, 2 esthesioneuroblastomas, and 1 desmoplastic small-round-cell tumor (DSRCT) were analysed for the occurrence of the major recurrent translocations, such as t(11;22)(q24;q12), t(21;22)(q22;q12), t(11;22)(p13;q12), t(2;13)(q35;q14), t(1;13)(p36;q14), and t(X;18)(p11;q11). METHODS: Nitrogen-frozen tissue material was analysed by means of Reverse Transcription followed by PCR (Polymerase-Chain Reaction) and nested PCR (RT-PCR). Specificity of the PCR products obtained was confirmed by non-isotopic Southern-Blot analysis with gene-specific probes and/or automated direct sequence analysis. RESULTS: 75 ETs have been shown to carry either a t(11;22) or t(21;22) translocation by identification of chimeric EWS-FLI-1 or EWS-ERG gene-fusion transcripts respectively. 3 ETs were lacking EWS/FLI-1 or EWS-ERG fusion products. 2 of these tumors were shown on review to have unusual morphological features for ETs. 8/19 RMS were initially diagnosed as alveolar RMS. These tumours were shown to carry either a t(2;13) translocation exhibiting chimeric PAX3-FKHR fusion transcripts or a t(1;13) translocation with PAX7-FKHR chimeric gene products. One RMS of the embryonal group also carried a t(1;13) translocation. Reevaluation demonstrated a partly alveolar morphology. In 8/9 synovial sarcomas a t(X;18) translocation was identified. Expression of a EWS-WTI gene-fusion product associated with a t(11;22) translocation was found in the DSRCT. None of these rearrangements were detected in the NBs and 2 esthesioneuroblastomas. CONCLUSIONS: Our results support the concept that the major recurrent translocations are histogenetically specific for a subset of sarcomas. Thus, the detection of tumor type-specific translocations represents an extremely useful diagnostic modality as an adjunct to surgical pathology.

Base Sequence↗
PubMedDate not supplied

[Chance coincidence of spondylolisthesis and osteoid osteoma of the spine--a case report].

Between 10 and 20% of all osteoid osteomas are located in the spine. Diagnosis is often hampered by atypical signs and symptoms and unclear X-rays. Striking (chance) X-ray findings in this case, a spondylolisthesis- can divert attention away from a correct diagnosis. Scintiscanning and computer tomography are essential for a correct diagnosis.

Adult↗
PubMedDate not supplied

[The deliberate intralesional tumor resection].

Two exemplary cases (giant cell tumor, osteochondroma) are described in order to show the problems associated with intralesional tumor excision. Quite frequently, the size and location of the tumor will permit an intralesional procedure only, with high risk of regrowth or further growth of the tumor. Patients should be informed of possible consequences.

Adult↗
PubMedDate not supplied

[Local control in Ewing sarcoma. Comparative results following intralesional, marginal and tumor resection with healthy bone].

According to the results obtained so far in the CESS studies there is evidently no difference, as regards the frequency of local recurrence, between patients who have been surgically treated only and those who have had surgery and subsequent radiation therapy, provided that Enneking's guidelines on tumor excision according to regions are adhered to. Generally speaking, the recommendation still applies that primary local treatment of Ewing's sarcoma should be surgical. Further follow-ups continue to be necessary to establish whether postoperative radiation can be dispensed with. Is has become clear that radiation therapy alone will result in equally good local control only with small Ewing's sarcomas which respond well to preoperative chemotherapy.

Bone Neoplasms↗
PubMedDate not supplied

[Segmental rod wiring of the spinous process].

Described is a new technique of segmental spinal instrumentation without sublaminar wiring. The same correction of scoliosis, primary and lasting stability is achieved in comparison to Luque's original method. Our technique is without danger to violate the structures in the spinal canal. Our results of the first twenty patients with scoliosis operated on are comparable to those results after Harrington's or Luque's instrumentation described in the literature. We used this method in the operative treatment of thirty-two patients with spine metastases. In any case there was a remarkable improvement of the quality of life in the remaining life-time.

Adolescent↗
PubMedDate not supplied

[Prognosis in Ewing sarcoma patients with initial pathological fractures of the primary tumor site].

In this retrospective analysis, data of 52 patients with Ewing's sarcoma or PNET with a pathological fracture in the area of the primary tumor were evaluated. All patients were treated according to the trials CESS 81, CESS 86 P, CESS 86, CESS 91 P and EICESS 92 of the German Society of Pediatric Oncology and Haematology (GPOH). At the date of evaluation (15. September 1994) all patients had completed treatment and had been under observation for at least one year following diagnosis. The median follow-up time was 28 months. 22 patients were female, 30 male. The median age was 12 years. 75% of primary tumors had a volume of > or = 100 ml. 30 patients presented with fractures in proximal, 12 in central and 10 in distal parts of the skeleton. 10 patients had primary metastases. The histological definition was Ewing's sarcoma (including atypical Ewing's sarcoma) in 43 patients, PNET in 8 and small-cell osteosarcoma in 1 patient. For local therapy the patients underwent surgery, definitive radiotherapy or a combination of both. The percentage of primary metastases in the group of the patients with pathological fractures is comparable to the whole reference group. The present analysis focuses on those patients with pathological fractures who had no metastases at diagnosis. The relapse-free survival of patients with a pathological fracture and no primary metastases is 58%, the overall survival 65%. These rates are similar to those of the reference group of protocol patients without pathological fractures at diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Osteosarcoma in 2 siblings. A case report].

With a brother and sister, osteosarcoma developed at the age of 11 and 14 respectively. With both there was no previous retinoblastoma or other bone disease with a proclivity to develop osteosarcoma. We discuss possible explanations for familial aggregation of osteosarcoma, citing external or genetic factors. We suggest that it is the retinoblastoma gene RB and the tumor suppressor gene p53 which play an important part in the development of osteosarcoma.

Adolescent↗
PubMedDate not supplied

Klinefelter's syndrome and Breast cancer.

Breast cancer in a patient with Klinefelter's syndrome is reported. Possible correlation between testosterone and estradiol serum levels after testosterone-enanthate substitution, estrogen receptors in tumor tissue and clinical symptomatology are discussed. The various theories of etiology concerning breast cancer in this syndrome are reviewed. The increased conversion of testosterone to estradiol at the therapy with androgens might be responsible for the development of breast cancer in Klinefelter's syndrome. The current way of treatment is described.

Adult↗
PubMedDate not supplied

The 'incidentaloma' of the pituitary gland. Is neurosurgery required?

We describe a series of 18 patients with an intrasellar mass incidentally discovered by computed tomography or magnetic resonance imaging. The average size of the mass was 13 mm, with a range from 5 to 25 mm. Initial ophthalmologic examination revealed bitemporal hemianopia in 2 patients. Results of routine endocrine testing showed partial hypopituitarism in 5 patients and growth hormone hypersecretion without signs and symptoms of acromegaly in 1 patient. Four patients underwent neurosurgery. Histologically, one chondroid chordoma and three pituitary adenomas were found. In the remaining 14 patients treated conservatively, repeated computed tomography and magnetic resonance imaging revealed no significant change in tumor size at the time of follow-up (median, 22 months). Our results suggest that the "incidentaloma" of the pituitary gland is a benign condition that does not necessarily require neurosurgical intervention.

Adenoma↗
PubMedDate not supplied

Intraoperative clotting factor dilution and activated hemostasis in children with Ewing's sarcoma or osteosarcoma: a prospective longitudinal study.

BACKGROUND: The study was designed to evaluate prospectively intraoperative changes in coagulation and fibrinolysis in young patients with Ewing's sarcoma (n = 12) or osteosarcoma (n = 12) who underwent major surgery, and to relate them to hematocrit (HCT) readings. MATERIALS AND METHODS: Blood samples (von Willebrand factor, fibrinogen, antithrombin III, protein C, plasminogen, t-PA ag, PAI 1 activity, F1+2, D-dimer, PAP) were obtained immediately prior to starting anesthesia, two and four hours later, immediately after surgery and on the first postoperative day. Intra- and postoperative hemostatic parameters were adjusted to preoperative HCT readings. RESULTS: Major surgery induced dilution coagulopathy due to blood product transfusion to support the patient's vascular volume. Postoperatively, VWF (0.01) and fibrinogen (0.007) were found to be significantly enhanced, whereas antithrombin III levels were significantly (0.007) decreased. D-dimer formation showed a clear, significant (0.0019) rise two hours after skin incision and remained elevated through the first postoperative day. F1+2 and PAP showed only minor deviations. T-PA (0.012) and PAI 1 (0.001) rose during the operation and normalized on the first postoperative day. Within 36 hours of the initial operation, six of the 24 patients (25%) returned to surgery to stop severe hemorrhage. CONCLUSIONS: These findings indicate that hemostatic parameters may be useful when monitoring surgery- and transfusion-induced hemostatic imbalance. Furthermore, the significant differences between the HCT-uncorrected concentration of the various plasma proteins clearly demonstrated the need to use HCT correction factors which may influence the necessity for and/or the frequency of substitution therapy with protein concentrates.

Adolescent↗
PubMedDate not supplied

Sleep apnoea in acromegaly--prevalence, pathogenesis and therapy. Report on two cases.

It has long been known, that irregular, heavy snoring and daytime sleepiness are common features of acromegaly. Only recently has the high incidence (30-60%) and clinical relevance of the sleep apnoea underlying these symptoms been recognized. Both diseases have a group of common symptoms and prognostic features: Increased cardiovascular and respiratory mortality, elevated incidence of hypertension, daytime sleepiness, decreased vitality, headaches and depression. These are very prominent in sleep apnoea and often reversible under treatment. In acromegaly their etiology has been widely unexplained and they commonly persist even when human growth hormone (hGH) levels remain normal after operative treatment. We report on 2 patients presenting with excessive daytime sleepiness and severe obstructive sleep apnoea caused by acromegaly. Both had macroglossia and hypertrophy of hypopharyngeal tissues regressive after surgical therapy. The average hGH-levels were 20 and 31 ng/ml before and 3 and 1.7 ng/ml several months after operation respectively. Apnoea indices and minimal oxygen saturations (SO2) were 59/h and 55/h, and 60% and 58% initially and improved postoperatively to 40/h and 50/h, and 72% and 70%. Polysomnographic parameters were normalized by NCPAP-therapy pre- and postoperatively and daytime sleepiness improved dramatically. In one patient the NCPAP-pressure could be decreased postoperatively. Since patients with sleep apnoea have an increased perioperative risk of hypoxia and because transsphenoidal operation and postoperative nasal tamponade were performed, both patients were tracheostomized perioperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromegaly↗
PubMedDate not supplied

Treatment outcome of pelvic sarcomas in young children: orthopaedic and oncologic analysis.

Five children with pelvic Ewing's sarcoma whose age was 6-10 years underwent reconstruction after resection of the tumor. One child with a tumor of the ilium underwent an iliosacral arthrodesis with allograft. Three patients underwent a hip transposition after the resection of the ilium and the upper part of the acetabulum. One patient underwent no skeletal reconstruction after the resection of the acetabulum and the ilium. Two children are alive 96 and 60 months after surgery; however, two died 12 and 21 months after surgery of metastasis, and one is alive with metastasis 15 months after surgery. Functional evaluation was possible in four patients: one is excellent, and three are fair. After resection of the ilium, including the upper part of the acetabulum, a hip transposition can be selected. If all the acetabulum is resected, it will be optimal not to do a bony reconstruction.

Bone Neoplasms↗