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W Winkelmann

Publications and source records attributed to W Winkelmann.

At least 37 records · Page 2Linked to original sources
PubMed2002

Reconstruction of the proximal humerus after wide resection of tumours.

In 45 patients we assessed the functional results and complications for three different reconstructive procedures after resection of primary tumours of the proximal humerus. An osteoarticular allograft was used in 11, a clavicula pro humero operation in 15 and a tumour prosthesis in 19. The glenoid was resected with the proximal humerus in 25 patients. The axillary nerve was resected in 42 patients. The complication rate was lowest after reconstruction with a tumour prosthesis. The clavicula pro humero operation resulted in the most revisions. Cumulative survival rates for all the reconstructive procedures were similar. At follow-up at two years the functional results for the three reconstructive procedures were the same with a mean functional rating of 79% (Musculoskeletal Tumor Society). Excision of the glenoid had no influence on the functional result. Our findings indicate that the use of a tumour prosthesis is the most reliable limb-salvage procedure for the proximal humerus. The clavicula pro humero is an appropriate procedure if a prosthesis cannot be used.

Adult↗
PubMed2002

Sweet's syndrome associated with pigmented villonodular synovitis.

Sweet's syndrome (acute febrile neutrophilic dermatosis) was first described in 1964. The typical symptoms of Sweet's syndrome are high temperature, peripheral leucocytosis, painful cutaneous rashes (papules, plaques) and arthralgia. Sweet's syndrome has particularly been described in association with neoplastic, infectious and immunological diseases. The pathogenesis of Sweet's syndrome can be explained by a reaction to an antigenic structure with accumulation of immunological complexes and liberation of inflammatory mediators. For the first time we report on a patient with Sweet's syndrome and pigmented villonodular synovitis, which is believed to play the antigenic role in the Sweet syndrome.

Humans↗
PubMed2001

The multicentric epitheloid hemangioendothelioma of bone: a case example and review of the literature.

Epitheloid hemangioendothelioma of bone is a rare primary bone malignancy. Diagnosis can be difficult for physicians who are not experienced with bone neoplasms. We also had difficulties in diagnosis and treatment in one of our patients with a multicentric epitheloid hemangioendothelioma involving the pelvis, left femur, and left tibia. We recommend a complete skeletal survey with magnetic resonance imaging because it can reveal previously undetected lesions on conventional radiographs. We performed an extraarticular resection of the hip joint including the spina iliaca anterior inferior, resection of the femur, and amputation of the lower leg. The femur was replaced by a modular endoprosthesis. The patient is provided with an above-knee prosthesis and is able to walk even longer distances with a cane 2 years after surgery. In our opinion it is necessary to perform a wide resection of this tumour in order to treat a patient with curative intention. Palliative radiotherapy should only be used for a non-resectable tumour or in metastatic disease. Chemotherapy is not a treatment option.

Adult↗
PubMed2001

Localized Ewing tumor of bone: final results of the cooperative Ewing's Sarcoma Study CESS 86.

PURPOSE: Cooperative Ewing's Sarcoma Study (CESS) 86 aimed at improving event-free survival (EFS) in patients with high-risk localized Ewing tumor of bone. PATIENTS AND METHODS: We analyzed 301 patients recruited from January 1986 to July 1991 (60% male; median age 15 years). Tumors of volume >100 mL and/or at central-axis sites qualified patients for "high risk" (HR, n = 241), and small extremity lesions for "standard risk" (SR, n = 52). Standard-risk patients received 12 courses of vincristine, cyclophosphamide, and doxorubicin alternating with actinomycin D (VACA); HR patients received ifosfamide instead of cyclophosphamide (VAIA). Tumor sites were pelvis (27%), other central axis (28%), femur (19%), or other extremity (26%). The initial tumor volume was <100 mL in 33% of cases and > or =100 mL in 67%. Local therapy was surgery (23%), surgery plus radiotherapy (49%), or radiotherapy alone (28%). Event-free survival rates were estimated by Kaplan-Meier analyses, comparisons were done by log-rank test, and risk factors were analyzed by Cox models. RESULTS: On May 1, 1999 (median time under study, 133 months), the 10-year EFS was 0.52. Event-free survival did not differ between SR-VACA (0.52) and HR-VAIA (0.51, P =.92). Tumor volume of >200 mL (EFS, 0.36 v 0.63 for smaller tumors; P =.0001) and poor histologic response (EFS, 0.38 v 0.64 for good responders; P =.0007) had negative impacts on EFS. In multivariate analyses, small tumor volumes of <200 mL, good histologic response, and VAIA chemotherapy augured for fair outcome. Six of 301 patients (2%) died under treatment, and four patients (1.3%) developed second malignancies. CONCLUSION: Fifty-two percent of CESS 86 patients survived after risk-adapted therapy. High-risk patients seem to have benefited from intensified treatment that incorporated ifosfamide.

Adolescent↗
PubMed2001

Genetic imbalances revealed by comparative genomic hybridization in Ewing tumors.

Ewing tumors are characterized by reciprocal translocations involving the EWS gene on 22q12 fused to ETS transcription-factor family members. Little is known about further aberrations contributing to tumor development and progression. Sixty-two frozen tumors with known EWS rearrangements (52 primary tumors, 10 relapses) of ET patients registered in the EICESS protocol were analyzed by comparative genomic hybridization (CGH). The median number of changes in 52 primary and 10 relapsed cases was 2.5 and 5.0 per tumor (P = 0.153). Frequent abnormalities included gains of chromosomes 8, 12, 20, and 1q and losses of 16q and 19q. Neither number nor type of aberration was associated with histology, tumor size, disease stage, tumor localization, or histologic tumor response to chemotherapy. Among the 52 primary tumors, 26 with Type I fusion (EWS exon 7 to FLI1 exon 6) and 26 with other fusion types had a median of 2.0 and 3.0 aberrations per tumor, respectively (P = 0.031). Combinations of gains of chromosomes 8 and 12, gains of chromosome 20, and either gains of 8q or 18q and losses of 16q and 17p frequently occurred. The cumulative overall survival (OAS) was different between 35 patients with <5 aberrations and 13 patients with > or =5 aberrations (P = 0.009). Univariate analysis showed that patients with gains of 1q, 2q, 12, and 20 or losses of 16q and 17p had significantly lower OAS than those without aberrations. By multivariate analysis, loss of 16q (relative risk [RR] = 5.3; P = 0.0006) was an independent prognostic factor.

Adolescent↗
PubMed2001

[Clinical value of positron emission tomography (PET) in the diagnosis of bone and soft tissue tumors. 3rd Interdisciplinary Consensus Conference "PET in Oncology": results of the Bone and Soft Tissue Study Group].

PURPOSE: In the framework of the 3rd Consensus Conference "PET in Oncology" the bone and soft-tissue tumors study group evaluated the present position of PET for these tumor entities on the basis of international publications. METHODS: After a systematic review of the literature, publications were evaluated according to previously defined quality criteria. For various indications the clinical usefulness of PET was assessed using a classification system. RESULTS: Most studies had been performed with a small number of patients (n < 35). Therefore, only 8 of 46 publications were judged relevant. On the basis of these literature data, use of FDG-PET for grading was classified 1b (literature results predominantly show clinical usefulness). As before (1995/97), all other indications were categorized with 3 (assessment not yet possible, literature data inadequate). OUTLOOK: According to the opinion of experts, the detection of osseous metastases of Ewing's sarcoma, therapy monitoring and the diagnosis of recurrences are potentially useful clinical indications for FDG-PET. Therefore, prospective studies with large patient groups are essential to further evaluate the benefit of FDG-PET in these indications.

Age Factors↗
PubMed2001

Computed direct magnification radiography of bone tumors.

The purpose of this study was to assess the diagnostic performance of computed direct magnification radiography in diagnosing bone tumors as compared with conventional radiography. Ninety-one patients with primary bone tumors and tumor-like lesions were radiographed with conventional and magnification techniques. All radiographs were analyzed by one orthopedic surgeon and two radiologists and the findings were correlated with histopathology. Two microfocal X-ray units were used for computed direct magnification radiography with a focal spot size of 20-130 microm. Using magnification versus conventional radiography, the diagnosis of benign and malignant lesions as well as the individual tumor diagnosis was obtained with higher accuracy (85% versus 71% and 69% versus 51%, respectively, P<0.01). Margins of destruction, periosteal reactions, and matrix patterns were evaluated with higher accuracy by all observers (P<0.01). We conclude that computed direct magnification radiography may improve evaluation and diagnosis of bone tumors.

Adult↗
PubMed2001

Osteoid osteoma: CT-guided percutaneous radiofrequency ablation and follow-up in 47 patients.

PURPOSE: To evaluate computed tomography (CT)-guided radiofrequency (RF) ablation as a minimally invasive therapy for osteoid osteoma with regard to technical and clinical success and immediate and delayed complications. MATERIALS AND METHODS: Forty-seven patients (age range, 8-41 y; mean age, 19.6 y) with osteoid osteomas (femur, n = 25; tibia, n = 15; pelvis, n = 2; humerus, n = 1; ulna, n = 1; talus, n = 1; calcaneus, n = 1; vertebral body, n = 1) were treated with CT-guided RF ablation in 15 cases after one (n = 10) or two (n = 5) unsuccessful attempts at open surgical resection. Percutaneous therapy was performed with use of general or spinal anesthesia. After localization of the nidus with 1-3-mm CT sections, osseous access was established with either a 2-mm coaxial drill system or an 11-gauge Jamshidi needle. RF ablation was performed at 90 degrees C for a period of 4-5 minutes with use of a rigid RF electrode with a diameter of 1 mm. The procedures were regarded as technically successful if the tip of the RF electrode could be placed within the center of the nidus and could be heated to the desired temperature. Clinical success of treatment was defined as permanent relief of pain and return to normal function without additional treatment. In case of persistence or recurrence of symptoms after RF ablation, treatment was regarded as secondarily successful if permanent relief of symptoms could be achieved in a second procedure. RESULTS: All procedures were technically successful. Clinical success was achieved in 94% of patients (44 of 47). Three patients had recurrence of pain 3, 5, and 7 months after treatment, respectively (mean observation interval, 22 mo). All recurrences were treated successfully in a second procedure (secondary success rate, 100%). No immediate or delayed complications were observed. CONCLUSION: CT-guided percutaneous RF ablation is a simple, minimally invasive, safe and highly effective technique for treatment of osteoid osteoma.

Adolescent↗
PubMed2001

[Injury patterns and prevention in World Cup windsurfing].

The aim of the present study was to analyze the injury patterns in professional world cup windsurfing. The one handed jumps and loops are combined with a high risk of injury. 49 world cup professional windsurfers (39 men, 10 women) could be asked regarding their injuries in their professional career. Questionnaires were used in German, English or French. Furthermore the windsurfers were asked about prophylaxis against injuries. 260 injuries could be stated: 43 injuries of the head (17%), 40 injuries of the trunk (15%), 23 injuries of the upper extremity (9%). The majority of the injuries were stated at the lower extremity (n = 154, 59%). As far as the lower extremity is concerned, the strain of the ankle joint was dominating (n = 57). With 22% of all mentioned injuries this was the most common injury and 61% of the windsurfers claimed about an injury of the ankle joint. An injury of the knee was stated in 30 windsurfers, whereby 80% of these injuries were severe injuries of the ligaments or the meniscus. Only 10% of the professionals used a helmet to prevent injuries of the head. The cause of the head injuries are the spectacular jumps like loopings or table tops. The cumulation of injuries of the lower extremity is due to the fixation of the feet in the footstraps. The fixation on the feet leads to extreme rotatory forces in the knee joint in case of a fall. Furthermore the fixation of the feet leads to a high rate of ankle joint strain. In order to prevent injuries a helmet should be used and special footstraps should be developed, which ensure a release of the foot in the danger area.

Adult↗
PubMed2001

[An extended CT scale technique for evaluating periprosthetic bone lesions - an in vitro study].

PURPOSE: In the present study the reduction of artifacts using an extended CT scale technique was examined in 5 vitallium and 5 titanium-aluminium-vanadium tumor prostheses. METHODS: 5 titanium-aluminium-vanadium and 5 vitallium distal femur Mutars(R) tumor prostheses (Mutars(R) - Modular Universal Tumor And Revision System) were implanted in 10 human femur specimens. 110 artifical drill hole lesions of 1 mm, 2 mm, 3 mm, 5 mm and 8 mm diameter were placed in the bone around the hexagonal stem of the tumor prosthesis and furthermore in the proximal part of the femur. All specimens were examined using conventional CT and an extended CT scale technique in a slice thickness of 3 mm. RESULTS: In the proximal part of the femur all drill holes could be detected using 3 mm slices, no artefacts were observed. Along the hexagonal stem smooth lines arising from each hexagonal plane could be observed. This made it impossible to detect a 1 mm drill in 1 vitallium and in 1 titanium-aluminium-vanadium stem. There was no difference between the extended CT scale and conventional CT. CONCLUSION: The extended CT scale did not significantly (p > 0.05, t-test) improve the imaging of artificial drill hole lesions along the hexagonal Mutras(R) stem.

Aged↗
PubMed2001

Stump lengthening after hip disarticulation using a modular endoprosthesis in 5 patients.

To reduce the disability after hip disarticulation, we developed a special surgical procedure in patients having a proximal femoral tumor with a large tumor involving the sciatic nerve or neoplasms involving the tibia and femur. The hip was disarticulated, but we preserved a musculocutaneous flap. A modular endoprosthesis was then placed in the acetabulum or, in case of an extraarticular resection of the hip joint, it was placed in the iliac bone. A trevira tube was used for reconstruction of the joint capsule and fixation of soft tissues. We performed this procedure in 5 patients who had a good functional outcome.

Adolescent↗
PubMed2001

The bisphosphonate pamidronate is a potent inhibitor of human osteosarcoma cell growth in vitro.

Bisphosphonates (BPs), such as pamidronate and clodronate, are an important class of drugs for the treatment of bone diseases. It is widely recognized that they inhibit bone resorption by suppressing the action of osteoclasts through antagonizing the mevalonate pathway, thereby reducing osteolytic bone metastases derived from different cancers, i.e. breast carcinoma and multiple myeloma. In contrast, the effects of BPs on primary bone tumors is an issue still to be resolved. Therefore, a systematic approach was set up to test the hypothesis that BPs could act directly on osteosarcoma cells. The effects of pamidronate and clodronate on seven osteosarcoma cell lines (HOS, MG-63, OST, SaOS-2, SJSA-1, U(2)OS and ZK-58) were studied. Pamidronate inhibited cell growth in a time- and dose-dependent manner, and decreased proliferation for up to 73% at 50 microM after 72 h, whereas its monophosphonate analog 3-aminopropyl phosphonate did not reduce cell viability at concentrations up to 2 mM. Clodronate showed less inhibitory effects (maximally 38% reduction at 1 mM after 72 h). Importantly, cell growth of fibroblasts was only very weakly affected by treatment with pamidronate. These results suggest that pamidronate may be a useful agent for the treatment of patients with osteosarcoma.

Antineoplastic Agents↗
PubMed2001

Occlusion of the left common iliac artery and consecutive thromboembolism of the left popliteal artery following anterior lumbar interbody fusion.

We report on a case of occlusion of the left common iliac artery due to arteriosclerosis and consecutive thrombotic occlusion of the left popliteal artery in a 52-year-old man following anterior retroperitoneal interbody fusion of L4--S1. Initial symptoms included leg pain and numbness of the lateral shank, which were thought to be a result of lumbar nerve root irritation from surgery. Diagnosis was not made until 13 days after surgery, when motor deficits were observed. Angiography showed occlusion of the left common iliac artery and thromboembolism of the left popliteal artery. After thromboendarterectomy of the common iliac artery and thrombectomy of the popliteal artery, motor deficits of the left foot were resolved whereas symptoms of pain and sensory deficits continued. Spine surgeons should be aware of this rare complication in cases of postoperative leg pain or of neurologic deficits in the lower extremity after anterior lumbar interbody fusions.

Angiography↗
PubMed2001

Rotationplasty type B IIIa according to Winkelmann: electromyography and gait analysis.

After resection of a malignant bone tumor of the femur, rotationplasty is considered a treatment option in addition to other limb salvage procedures such as endoprosthetic replacement, allograft, or autograft reconstruction. A Type B IIIa rotationplasty is indicated when the tumor involves the total femur or when skip lesions are detected. After the total femur is resected, the lateral tibial plateau is placed into the acetabulum after rotating the tibia and foot segment 180 degrees. Eight patients at an average age of 5.9 years underwent a rotationplasty Type B IIIa at the authors' institution. After a median followup of 59.6 months (range, 24-86 months) the clinical results were excellent and the functional status according to the criteria of the Musculoskeletal Tumor Society was good (23 of 30 points). In electromyographic analysis the muscle activity of the affected leg revealed good function of the stance and the swing phase muscles according to their new function with comparable amplitudes to the unaffected limb. The kinematics (range of motion of the hip and knee) were slightly assymmetric. Gait analysis showed a slight lateral trunk lean over the ipsilateral limb with reduced joint moment. All patients had full weightbearing ability. Remodeling of the tibial plateau into a round form mimicking a new femoral head is confirmed by radiographs and magnetic resonance imaging scans. In young children with a tumor of the total femur, rotationplasty Type B IIIa is a good treatment modality with excellent clinical and good functional results. The electromyographic and gait analysis data underscore a good functional restoration of gait after rotationplasty.

Bone Transplantation↗
PubMed2001

Cyclooxygenase-2 inhibitor for pain management in osteoid osteoma.

Thirteen patients with osteoid osteoma were enrolled in a prospective trial to test whether rofecoxib, a selective cyclooxygenase-2 inhibitor, is as effective for pain control as acetylsalicylic acid. Each patient documented the pain level using a visual analog scale, with 0 being no pain and 10 being unbearable pain, during 2 days of no pain medication, 4 days of 500 mg acetylsalicylic acid three times a day, and 10 days of 25 mg rofecoxib once a day. Oral administration of 500 mg acetylsalicylic acid three times a day led to a significant decrease in pain at night, pain at rest, and pain induced by exercise. Twenty-five milligrams rofecoxib given once a day at midday showed the same remarkable improvement in pain at night, pain at rest, and pain induced by exercise. Rofecoxib in comparison with acetylsalicylic acid showed a trend toward lower pain levels in all categories. Rofecoxib offered a significantly better reduction in pain at rest during the day than did acetylsalicylic acid. Results of the current study suggest that pain induction in osteoid osteoma is related to cyclooxygenase-2, an enzyme that is blocked by acetylsalicylic acid and rofecoxib. Conservative medical treatment with rofecoxib for osteoid osteoma is recommended when percutaneous intervention is associated with significant morbidity.

Adolescent↗
PubMed2001

Soft tissue reconstruction of megaprostheses using a trevira tube.

In soft tissue reconstruction of megaprostheses, the reattachment of soft tissue and joint capsules is essential. Sixty-nine megaprostheses were implanted and a trevira tube was applied to support reconstruction of the capsule and soft tissue. In cases of proximal femur replacement (33 patients), total femur replacement (five patients), and proximal humerus replacement (16 patients), the trevira tube allowed for reconstruction of the capsule and refixation of the muscles and helped to minimize dislocation. In cases of proximal tibia replacement (seven patients), arthrodesis of the knee (three patients), total knee replacement (two patients), and distal femur replacement (three patients), the trevira tube allowed for attachment of muscle flaps and extensor apparatus. Dislocation was observed in two of 54 patients who had proximal femur replacements. No dislocation was observed in patients with a total femur endoprosthesis or a proximal humerus endoprosthesis. The trevira tube also was used to attach the gastrocnemius muscle in patients with a proximal tibia endoprosthesis and to reattach the rotator cuff in patients with a proximal humerus prosthesis. There was no significant increase in the rate of infection. The histopathologic findings in six patients showed tissue ingrowth into the tube.

Adolescent↗
PubMed2001

Percutaneous radiofrequency ablation in osteoid osteoma.

We treated 58 patients with osteoid osteoma by CT-guided radiofrequency ablation (RF). In 16 it followed one or two unsuccessful open procedures. It was performed under general anaesthesia in 48, and spinal anaesthesia in ten. The nidus was first located by thin-cut CT (2 to 3 mm) sections. In hard bony areas a 2 mm coaxial drill system was applied. In softer areas an 11-gauge Jamshidi needle was inserted to allow the passage of a 1 mm RF probe into the centre of the nidus. RF ablation was administered at 90 degrees C for a period of four to five minutes. Three patients had recurrence of pain three, five and seven months after treatment, respectively, and a second percutaneous procedure was successful. Thus, the primary rate of success for all patients was 95% and the secondary rate was 100%. One minor complication was encountered. CT-guided RF ablation is a safe, simple and effective method of treatment for osteoid osteoma.

Adolescent↗