Biomedical subjects

Bruno Fuchs

Publications and source records attributed to Bruno Fuchs.

7 recordsLinked to original sources

PubMed2003

Femoral osteotomy and iliac graft vascularization for femoral head osteonecrosis.

The objective of this study was to determine the long-term clinical and radiologic outcomes of patients with osteonecrosis treated by a combination of intertrochanteric osteotomy and pedicled iliac bone block transfer. Between 1978 and 1986, 41 patients (52 hips) with a mean age of 33 years were operated on for Ficat Stages II and III disease. Thirty-three patients (44 hips) were assessed clinically and radiologically at a mean followup of 13.5 years (range, 5-20 years). Fifteen hips (15 of 44; 34%; 13 patients) had conversion surgery to a total hip arthroplasty because of progressive arthritis or collapse, or both. Six patients died and two were lost to followup. Preoperatively, the patients with failed revascularization had significantly more pain and decreased gait function than patients without failure. In the patients without failure, postoperative pain sensation and gait function improved significantly. However, flexion became restricted mainly because of progressive degeneration of the hip. Radiographically, 31% of the hips (nine hips; six patients) had severe arthritis, 59% (17 hips; 12 patients) had moderate arthritis, and only three hips (two patients) had mild arthritis. Ninety percent of patients without hip failures (26 of 29 hips; 18 patients) considered the functional outcome, including pain relief and gait function, to be successful. Despite the subjective success, this surgery could not restore normal hip anatomy, and arthritis progressed with time. Intertrochanteric osteotomy and vascularized iliac bone block transfer should be considered only in young symptomatic patients with good preoperative clinical function and Ficat Stage II disease.

Adolescent↗

PubMed2002

The human homolog of yeast SEP1 is a novel candidate tumor suppressor gene in osteogenic sarcoma.

The hSEP1 gene is the human homolog of yeast SEP1. Yeast SEP1 is a multifunctional gene that regulates a variety of nuclear and cytoplasmic functions including homologous recombination, meiosis, telomere maintenance, RNA metabolism and microtubule assembly. The function of hSEP1 is not known. We show loss or reduced expression of hSEP1 messenger RNA (mRNA) in three of four primary osteogenic sarcoma (OGS)-derived cell lines and in eight of nine OGS biopsy specimen. In addition, we find a heterozygous missense mutation (Valine(1484)>Alanine) at a conserved amino acid in the primary OGS-derived cell line U2OS. Importantly, we identified a homozygous missense mutation involving a CG-dinucleotide leading to a change in a conserved amino acid, aspartic acid(1137) >asparagine, in the primary OGS-derived cell line, TE85. hSEP1 mRNA expression was nearly undetectable in TE85 and low in U2OS cell lines. None of these mutations were identified in 20 normal samples consisting of bone, cartilage and fibroblast. The hSEP1 gene is located in chromosome 3 at 3q25-26.1 between markers D3S1309 and D3S1569. An adjacent locus defined by the polymorphic markers D3S1212 and D3S1245 has previously been reported to undergo loss of heterozygosity (LOH) at a >70% frequency in OGS and claimed to harbor an important tumor suppressor gene in osteosarcoma. The homozygous mutation in the hSEP1 mRNA in TE85 cell line suggest that this gene itself is subject to LOH. Taken together, these results suggest that hSEP1 acts as a tumor suppressor gene in OGS.

Base Sequence↗

PubMed2002

Combined posterior pelvis and lumbar spine resection for sarcoma.

The oncologic outcome in the treatment of pelvic sarcomas is not comparable with that in the extremity. Particular problems arise when the tumor involves the posterior pelvis and the sacrum or even the lower lumbar spine. Because of the difficulty in achieving local control and the major functional deficits after extensive surgery, some authors suggest conservative, nonsurgical treatment for these patients. The purpose of the current study was to analyze the oncologic outcome of patients who were treated for a pelvic sarcoma necessitating resection of the ilium, part of the sacrum and part of the lower spine, which is defined as extended hemipelvectomy. Between 1979 and 1999, 11 males and seven females with a mean age of 34.5 years (range, 14-67 years) had an extended hemipelvectomy for a sarcoma of the posterior pelvis. The tumors included seven osteogenic sarcomas, six chondrosarcomas, and five fibrosarcomas: 13 were classified as high-grade lesions. The mean size of the tumor was 11 x 9 x 6 cm. In 11 patients, a hemivertebrectomy of L5 and in seven patients of L4 combined with L5 was done to achieve an adequate margin. In four patients, the resection was followed by reconstruction with a vascularized fibula or autograft. At a mean followup of 56 months (range, 3-220 months), 12 of 18 patients were alive and without disease. Six patients died; four of these patients had metastasis to the lung at presentation. The two remaining patients died of complications of adjuvant treatment. The authors conclude from this small series of patients that an aggressive surgical resection for localized, nonmetastatic, high-grade sarcomas of the posterior pelvis may be justified to provide local control and improve survival.

Adolescent↗

PubMed2002

Iliofemoral arthrodesis and pseudarthrosis: a long-term functional outcome evaluation.

Reconstruction after the resection of pelvic tumors is a major challenge. It depends on many factors such as age, activity level, type of tumor, its adjuvant treatment, and the extent of the disease. The purpose of the current study was to analyze the functional and oncologic outcomes of patients who had an iliofemoral arthrodesis after resection of a pelvic sarcoma. Between 1981 and 1999, 20 males and 12 females with a mean age of 39.9 years (range, 10-71 years) had an iliofemoral arthrodesis, either as a solid fusion or primary pseudarthrosis, at one institution. The functional outcome was evaluated using the Musculoskeletal Tumor Society and the Toronto Extremity Salvage scores. At a mean followup of 97 months (range, 14-226 months), 15 of 32 patients were alive, all without disease. The radiographic union rate was 86%. The mean overall Musculoskeletal Tumor Society and Toronto Extremity Salvage scores were 64% and 48%, respectively. Patients with a primary solid fusion did functionally better compared with patients who had pseudarthrosis (Toronto Extremity Salvage Score, 76%; Musculoskeletal Tumor Society Score, 71% versus Toronto Extremity Salvage Score, 52%; Musculoskeletal Tumor Society Score, 25%). Biomechanical analysis showed that the loss of motion in the hip is well-compensated. The authors conclude from this series that iliofemoral reconstruction after resection of a pelvic sarcoma provides acceptable and durable long-term results, not only from the oncologic, but also from the functional perspective.

Adolescent↗

PubMed2002

Bowel and bladder function after major sacral resection.

Major sacral resection generally is reserved for patients with malignant lesions. Because of the uncommon nature of these diseases, little is known about outcomes of surgical treatment. The current authors describe the retrospective analysis of bowel and bladder function in patients having major sacral resection at their institution during a 10-year period. Fifty-three patients were identified. In patients who had unilateral sacrectomy, in whom the contralateral sacral nerves were preserved, normal bowel and bladder function was retained in 87% and 89%, respectively. In patients who had bilateral S2-S5 nerve roots sacrificed, all had abnormal bowel and bladder function. In patients who had bilateral S3-S5 resection, normal bowel and bladder function was retained in 40% and 25%, respectively. In patients who had bilateral S4-S5 resection, with preservation of the S3 nerves bilaterally, normal bowel and bladder function was retained in 100% and 69%, respectively. In patients who had asymmetric sacral resections, with preservation of at least one S3 nerve root, normal bowel and bladder function was retained in 67% and 60%, respectively. These results show that unilateral resection of sacral roots or preservation of at least one S3 root in bilateral resection preserves bowel and bladder function in the majority of patients.

Adolescent↗

PubMed2002

Etiology of osteosarcoma.

Although the prognosis and quality of life of patients with osteosarcoma were improved significantly during the past decades, the pathogenesis and etiology of this disease remain obscure. Significant interest and effort in this cancer led to the identification of numerous etiologic agents. Several chemical agents such as beryllium, viruses such as FBJ, subsequently found to contain the src-oncogene, and radiation were shown to be potent inducers of osteosarcoma. Paget's disease, electrical burn, or trauma all are thought to be other factors that may contribute to the pathogenesis. More recently, patients with hereditary diseases such as Rothmund-Thomson syndrome, Bloom syndrome, and Li-Fraumeni syndrome were found to have an increased risk of having osteosarcoma develop. During the past few years, the molecular analysis brought a wealth of new information with numerous genes that were associated with osteosarcoma and its clinical disease progression. They can be categorized into self-sufficiency in growth signals, insensitivity to growth inhibitory signals, evasion of apoptosis, limitless replicative potential, sustained angiogenesis, and tissue evasion and metastasis. Although the understanding of these processes in osteosarcoma still is incomplete, it may have the potential to significantly affect the patient care in the future.

Animals↗

PubMed2002

Relationship between surgical margins and local recurrence in sarcomas of the spine.

The combination of improved resection, stabilization, and fusion techniques allows for more aggressive removal of malignant spinal tumors with acceptable mortality and morbidity. Thirty consecutive patients with primary sarcomas of the mobile spine, who were operated on at the authors' institution from January 1970 to December 2000, were included in the current study. Demographic information, tumor location, type of resection, resection margins, local recurrence, and overall survival data were retrieved and analyzed. Treatment consisted of en bloc resection in 12 patients (40%) and piecemeal resections in 18 patients (60%). The resection was classified as wide in seven patients (23.3%), marginal in three patients (10%), and intralesional in 20 patients (66.7%). Pathology reports showed tumor-free resection margins in 12 patients (40%). In the remaining 18 patients (60%), resection margins were positive and resulted in a fivefold increase in the risk of a local recurrence. Ninety-two percent of the patients with local recurrence died of sequelae associated with the local recurrence. Primary sarcomas of the mobile spine in certain cases, can be removed completely with tumor-free resection margins. En bloc resection with tumor-free margins provides substantial improvement in overall survival.

Adolescent↗