Gluteale Insuffizienz Banke, I. J.; Prodinger, P. M.; Weber, M. ...
Der Orthopäde,
08/2020, Letnik:
49, Številka:
8
Journal Article
Zusammenfassung
Die gluteale Insuffizienz oder Insuffizienz der Hüftabduktoren, vordergründig nach (Revisions‑)Endoprothetik, geht mit einem ausgeprägten klinischen Beschwerdebild und einem starken ...Leidensdruck einher. Sie stellt eine große diagnostische und therapeutische Herausforderung dar. Differenzierte konservative Behandlungspfade, offen chirurgische/endoskopische anatomische Rekonstruktionstechniken bei intakter Glutealmuskulatur und Muskelverschiebeplastiken als Reserveoption bei nicht anatomisch rekonstruierbarer Massenruptur stehen zur Verfügung. Ein schrittweises diagnostisch therapeutisches Vorgehen ist angezeigt zur Wiederherstellung von Lebensqualität und schmerzfreier oder schmerzarmer Mobilität der betroffenen Patienten in Beruf und Alltag.
Hypoxia-inducible factor (HIF)1 alpha is considered to play a key role in the adaptation of cells to hypoxia by stimulating angiogenesis via regulation of vascular endothelial growth factor and by ...metabolic adaptation to O(2) deprivation.
Expression of HIF-1 alpha protein and p53 was investigated by immunohistochemistry in 51 specimens of supratentorial pure oligodendrogliomas. Microvessels density (MVD) was determined by anti-CD34 immunostaining. The influence of HIF-1 alpha expression on survival was investigated using univariate and multivariate analysis.
Strong expression of HIF-1 alpha was observed in 12 (23.5%) specimens, moderate in 21 (41.2%) specimens, and weak in 8 (15.7%) cases, and no expression was found in 10 samples (19.6%). There was no correlation of HIF-1 alpha expression with histologic grading (P = 0.428, Mann-Whitney test). Hypoxia-inducible factor-1 alpha expression and MVD showed a strong correlation (P < 0.001, r = 0.735, Spearman coefficient of correlation). Overexpression of p53 was observed in only two cases. Patients with strong or moderate expression of HIF-1 alpha had a significantly shorter overall survival rate compared with those with low or no expression in univariate (P = 0.0434; log-rank test) and multivariate analysis (P = 0.0187).
Overexpression of HIF-1 alpha indicates a diminished prognosis in oligodendrogliomas, independent of p53 status. This finding may be explained by the strong vascularization of these tumors that prevents hypoxia and allows O(2) diffusion and henceforth tumor progression.
The number of periprosthetic fractures following hip replacement is increasing due to longer life expectancy and the rising number of joint replacements. The main causes of periprosthetic fractures ...include trauma, implant specific factors or loosening of the endoprosthesis. When planning therapy, surgeons should consider specific and general implant- and patient-related risk factors to ensure the best possible treatment. Established classification systems can facilitate preoperative planning. At present, the Vancouver classification system probably comes closest to the ideal, as it considers fracture configuration, stability of the implant and quality of the bone stock. Depending on these factors, therapeutic options include conservative treatment, fracture stabilisation or replacement of the endoprosthesis. The problems associated with periprosthetic fractures of varying etiology and the available treatment options are discussed against the background of the established classification systems.
Out of all skeletal metastases 30% are located in the spine as are 10% of primary bone tumors, whereby 52% of metastases occur in the lumbar region, 36% in the thoracic spine and 12% in the cervical ...spine. Patients suffer from local pain caused by irritation of the periosteum due to rapid growth of the tumor or subsequent pathologic fractures which may lead to compression and neurological impairment with paresthesia, paresis and paraplegia. If the diagnosis cannot be confirmed exactly by radiological imaging and laboratory tests, a biopsy should be performed. A precise diagnosis of the tumor entity as well as an estimation of the prognosis provides an important basis for further decision-making. The aim of therapy is pain relief and stabilization by operative and non-operative measures. Therapy is palliative with the aim of pain relief and preservation of mobility. In cases of solitary metastasis a curative operative treatment should be performed.
Sclerosing epithelioid fibrosarcoma (SEF) is a rare soft tissue sarcoma mostly occurring in extraosseous sites. SEF represents a clinically challenging entity especially because no standardized ...treatment regimens are available. Intraosseous localization is an additional challenge with respect to the therapeutical approach. We report on a 16-year-old patient with SEF of the right proximal tibia. The patient underwent standardized neoadjuvant chemotherapy analogous to the EURAMOS-1 protocol for the treatment of osteosarcoma followed by tumor resection and endoprosthetic reconstruction. Histopathological analysis of the resected tumor showed >90% vital tumor cells suggesting no response to chemotherapy. Therefore, therapy was reassigned to the CWS 2002 High-Risk protocol for the treatment of soft tissue sarcoma. To date (22 months after diagnosis), there is no evidence of relapse or metastasis. Our data suggest that SEF may be resistant to a chemotherapy regimen containing Cisplatin, Doxorubicin, and Methotrexate, which should be considered in planning treatment for patients with SEF.
A cluster of 10 cases of tuberculosis disease (one of them extrapulmonary) occurred from July 2001 until November 2003 in a health district in Southern Austria. Eight patients were culture confirmed ...and shared an identical strain. One of these eight cases was identified as outbreak-related by molecular strain typing only. Due to public pressure, a further 600 persons received chest X-ray and clinical examinations. Apart from one case which could be excluded from the outbreak because of a different strain pattern, no outbreak-related case of active tuberculosis was detected by this non-targeted procedure. Tuberculin skin testing, not part of the Austrian routine protocol of contact investigation in adults, was initiated after diagnosis of case 8. Forty-nine latently infected contacts were detected. Population-based genotyping of all isolates, prioritization of contact investigations and early use of targeted tuberculin skin testing are critical for effective tuberculosis control in low-incidence countries.
Several European countries report a decreasing prevalence of antibodies to hepatitis A virus (anti-HAV). This trend is most pronounced in the youngest age groups. In 1979, however, 58% of young ...Austrians aged 20 to 30 years were shown to possess anti-HAV. Here we describe the current epidemiological situation in western Austria. Prevalence of anti-HAV has decreased to 7% in those 18 to 30 years old. This percentage rises to 20% (31 to 40 years of age) and 57% (41 to 50 years of age) and is highest in those older than 50 years (87%). Of 180 cases of clinical hepatitis A occurring from 1985 to 1992 45% were imported by travel to HAV-endemic areas. Seventy-one percent of the cases in children (59/83) occurred in foreign workers' families and were also predominantly acquired abroad. A change in prevention policy should be considered in this respect, as vaccination is available now.
Zusammenfassung
Hintergrund
Der periprothetische Gelenkinfekt (PPI) gilt als große diagnostische und therapeutische Herausforderung. Er schmälert den Therapieerfolg, stellt eine enorme Belastung für ...die betroffenen Patienten dar und zieht häufig aufwendige operative Revisionen nach sich. Ein schrittweises aufwendiges diagnostisches Vorgehen ist hier bisher angezeigt, um zeit- und kostenintensive Irrläufe zu vermeiden. Die gegenwärtige (Gold-)Standarddiagnostik kommt jedoch insbesondere beim häufigen und klinisch relevanten chronischen „low-grade“-PPI an ihre Grenzen.
Einschätzung
Synoviale Biomarker zur sicheren Differenzierung einer aseptischen von der (chronischen) septischen sowie der implantatallergischen Beschwerdeursache und der Arthrofibrose werden momentan zur Überwindung der diagnostischen Lücke favorisiert. Die ambulant durchführbare Synovialpunktion ist dabei der operativen Synovial-(is-)Biopsie bei früherem Diagnosezeitpunkt, höherer Alltagspraktikabilität, geringerer Patientengefährdung und schließlich geringeren Kosten überlegen. Neben Parametern wie Interleukin-6 (IL-6), C-reaktives Protein (CRP) und Leukozytenesterase in der Gelenkflüssigkeit gelten innovative synoviale Biomarker aus der Gruppe der antimikrobiellen Peptide und proinflammatorischen Zytokine aufgrund sehr guter bis exzellenter diagnostischer Genauigkeit als besonders vielversprechend.
Schlussfolgerung
Welches (differenzial-)diagnostische Set verschiedener Biomarker bei der innovativen „one-stop-shop“-Strategie der synovialen Infektdiagnostik künftig zu favorisieren ist, müssen unabhängige Multicenter-Validierungsstudien zeigen.
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