Biomedical subjects

I Melcher

Publications and source records attributed to I Melcher.

18 recordsLinked to original sources

PubMed2006

[Management problems in the diagnostic work-up and treatment of pathological fracture of the proximal femur. Clinical case report].

Pathological fractures caused by primary bone tumours are rare compared with fractures evolving in response to general osteoporosis or bone metastases. Nevertheless in cases of fracture due to inadequate trauma the underlying causality has to be clarified including histological analysis prior to the operating procedure. This case report demonstrates diagnostic and therapeutic standards in cases of pathological fracture of the proximal femur caused by osteosarcoma.

Adult↗

PubMed2006

Percutaneous balloon kyphoplasty in the treatment of pathological vertebral body fracture and deformity in multiple myeloma: a one-year follow-up.

PURPOSE: To evaluate the clinical and radiographic outcomes of balloon kyphoplasty in patients with fractures of the thoracic and lumbar spine caused by multiple myeloma. MATERIAL AND METHODS: Vertebral fractures due to multiple myeloma were treated by balloon kyphoplasty (20 patients, 48 vertebral bodies). Symptomatic levels were identified by clinical presentation, magnetic resonance imaging (MRI), radiographs, and computed tomography (CT). During the following year, visual analog scale (VAS) and Oswestry disability score were documented. Radiographs were taken pre- and postoperatively at 3, 6, and 12 months. Vertebral height and kyphotic deformity were measured to assess restoration of the sagittal alignment. RESULTS: The median pain scores (VAS) decreased significantly from pre- to posttreatment, as did the Oswestry disability score (p < 0.05). Clinically asymptomatic cement leakage occurred at 5 fracture levels (10.4%). During 1-year follow-up, this surgical technique demonstrated restoration and stabilization of the height of the vertebral body. CONCLUSION: Balloon kyphoplasty is an effective minimally invasive procedure for stabilizing pathological vertebral fractures caused by multiple myeloma and leading to a statistically significant reduction of pain status. Balloon kyphoplasty stabilizes the vertebral body height, but is only partially able to prevent further kyphotic deformities.

Aged↗

PubMed2006

Maintained pain reduction in five patients with multiple myeloma 12 months after treatment of the involved cervical vertebrae with vertebroplasty.

PURPOSE: To evaluate in a prospective study the clinical and radiographic outcome of vertebroplasty in patients with osteolytic lesions of the cervical spine caused by multiple myeloma. MATERIAL AND METHODS: Pathological vertebral fractures associated with multiple myeloma were treated in five patients. Vertebroplasty was performed in 12 vertebral bodies. Symptomatic levels were identified by correlating the clinical presentation with magnetic resonance imaging (MRI), conventional radiographs, and computed tomography (CT). During the 12-month follow-up, pain symptoms were measured on a self-reported visual analog scale (VAS), neck pain disability index (NPDI, range 0-100%), and cervical spine functional score (CSFS, range 0-100). Medical imaging was performed pre- and postoperatively and after 3, 6, and 12 months. The vertebral height was measured to assess the restoration of the sagittal alignment. RESULTS: The median pain scores (VAS) as well as the NPDI and CSFS decreased significantly after vertebroplasty (P<0.05). Cement leakage occurred in two of 12 vertebral bodies (16.6%), without clinical relevance. The vertebral body height was stabilized during follow-up. CONCLUSION: Vertebroplasty in the cervical spine is an effective open surgical procedure for the stabilization of pathological vertebral fractures caused by multiple myeloma leading to a statistically significant reduction of pain status. Vertebral body height is stabilized and further deformities are avoided.

Aged↗

PubMed2005

[60 year old patient with soft tissue infection of the right leg].

Group A streptococcal necrotizing fasciitis is a rare disease associated with high mortality. Since severe toxic shock syndrome is a common complication, only immediate and aggressive surgical intervention, adequate antimicrobial therapy and supportive intensive care can be life-saving. We report about successful treatment of a 60-year old patient with necrotizing fasciitis and multiple organ failure.

Anti-Bacterial Agents↗

PubMed2004

[The multidisciplinary approach to reconstructive surgery of the extremities-considerations for trauma and orthopedic surgery].

Interdisciplinary reconstructive surgery of the extremities involves a variety of indications ranging from IIIB/C open fractures with major segmental loss of bone and soft tissue, to arterial vessel injury necessitating vascular repair, and to biological, plastic reconstruction following resection of musculoskeletal tumors. The multidisciplinary approach involving trauma/orthopedic surgery combined with vascular, plastic, and neuro- resp. microsurgery has significantly increased the rate of limb-sparing operations and improved morbidity, function, quality of life, and long-term oncological outcome. The multidisciplinary treatment of both complex trauma and malignant bone/soft tissue sarcoma of the extremity is an integral task of surgical trauma and tumor centers. Close interactive communication between the individual surgical disciplines has decisively influenced prognosis and is the precondition for priority-adapted therapeutic strategies.

Amputation, Surgical↗

PubMed2004

[Interdisciplinarity in reconstructive surgery of the extremities].

From the perspective of trauma and orthopedic surgery interdisciplinary reconstructive surgery of the extremities encompasses different indications ranging from IIIB/Copen fractures with major segmental loss of bone and soft tissue, to arterial vessel in-jury necessitating vascular repair and to biological, plastic reconstructions following resections of musculoskeletal tumors. The interdisciplinary treatment concept including trauma-orthopedic surgery combined with vascular, plastic and neuro- as well as microsurgery has significantly decreased amputation rates and functional deficits thereby improving quality of life and long-term oncological outcome The multisdisciplinary management of both complex trauma and malignant bone/ soft tissue sarcoma of the extremity is an integral task of the surgical trauma or tumor center. Close interdisciplinary communication and expierence are the precondition for performance of a priority-adapted therapeutic strategy, low complication rates and improvement of overall prognosis.

Extremities↗

PubMed2003

[CT and fluoroscopy based navigation in pelvic surgery].

Navigation procedures based upon CT data were introduced into spine surgery in 1994. Since then the method has been used in other areas, such as joint replacement, reconstructive surgery and tumor surgery, because of its high precision and reduced radiation exposure. The original CT-based spine module can be adapted for pelvic surgery with the prerequisite, that the positioning of the fragments is identical in CT and at operation; otherwise, a new data set has to be acquired. The experience with CT-based navigation in pelvic surgery will be explained in the context of five percutaneous screw fixations and three tumor resections. The technique will be described. The fluoroscopy-based navigation has been used in trauma surgery since the late 1990 s. Since than the method has gained wide acceptance in the field of joint replacement and reconstructive surgery as well. Between June 2000 and December 2002 we performed 36 percutaneous screw fixations in the pelvis with postoperative X-ray and CT control. Thirty five of the 36 screws were placed correctly. In one screw an anterior cortex perforation of the sacrum was seen on CT, but without neurological consequences. Based upon our clinical experience we believe that CT-based navigation is indicated in screw fixations for minimally displaced pelvic injuries or dysplasia and, with increasing importance, in tumor surgery. Fluoroscopy based navigation with adequate image quality is the method of choice for SI screw fixations in traumatic or degenerative instabilities, especially if an update of the images is needed.

Bone Neoplasms↗

PubMed2003

Unknown AV-fistula as reason for post-traumatic hematoma of the thigh.

A case is reported of a 28-year-old patient with gradually developing massive swelling of the right thigh after sustaining a blunt trauma. 3 1/2 months after the injury, surgery was performed because of a persisting tumor at the thigh. Intraoperatively, massive bleeding occurred, the bleeding vessel was sutured. Postoperative angiography disclosed arteriovenous (av) fistulae from the internal iliacal artery to a gluteal vein as source for the bleeding. The feeding artery was closed by coiling, the patient recovered completely. To the authors' knowledge, development of an av-fistula following blunt trauma has not been described previously. Similarly, the differential diagnosis of a posttraumatic bleeding of a congenital av-malformation was not yet reported. The authors emphasize, that prior to the surgery of inadequately behaving hematomas, an angiography should be performed.

Adult↗

PubMed2002

[Treatment concepts of benign bone tumors and tumor-like bone lesions].

The indications for surgical treatment of benign bone tumors and tumor-like lesions depend on the biological activity, clinical symptoms and anatomic location of the the lesion. Clinically silent lesions ("leave me alone Lesions") lacking any scintigraphic enhancement and without danger of pathologic fracture or malign transformation only need surveillance and do not require surgery.However, tumors becoming symptomatic, displaying progression after termination of skeletal growth or radiographic signs of malignancy should be scheduled for surgical intervention. For most benign tumors intralesional curettage and subsequent bone grafting is the treatment of choice, maintaining structural integrity and functional stability of the bone and adjacent joint. In case of uncertain histopathological diagnosis an open biopsy should be performed followed by definitive either marginal or en-bloc resection, preferably at a single procedure. Depending on the tumor-specific risk of recurrence, adjuvant measures as phenol instillation or cryotherapy using liquid nitrogen may additionally be applied. As for the unicameral juvenile bone cyst or osteoid osteoma alternative minimal invasive techniques like corticoid injection and CT-guided percutaneous eradication of the nidus have been successfully introduced into clinical practice. Depending on the activity of the tumor recurrent lesions are recommended to be treated by marginal or enbloc resection. The radical and aggressive mode of surgical therapy has to be balanced with the treatment-related morbidity, i.e. complication rate, possibilities for reconstructive stabilizations and resultant functional deficits,making the decision a responsible challenge to the orthopedic surgeon.

Adolescent↗

PubMed2002

[Bone tumors].

Explore the source record for details and available documents.

Bone Neoplasms↗

PubMed2002

Osseous integration of hydroxyapatite grafts in metaphyseal bone defects of the proximal tibia (CT-study).

PURPOSE OF THE STUDY: The purpose of the study was the examination of the osseous integration of hydroxyapatite grafts used for the filling of metaphyseal bone defects in tibia head fractures. MATERIAL: Four patients with lateral tibia plateau fractures AO-type B3 (12) were included in the study. Patients were treated by arthroscopically assisted reduction and percutaneous screw fixation. The metaphyseal bone defects were filled with prepared solid hydroxyapatite graft blocks (Endobon Fa. Merk Darmstadt, Germany). In all of the patients a CT study for the osseous integration of hydroxyapatite grafts used for the filling of metaphyseal bone defects in tibial head fractures was performed. Measurements of density were performed of the implant region, the periimplant region, the distant periimplant region and the fibula bone. Follow-up CT examinations of these specific regions were performed 6 and 12 months postoperative. RESULTS: In all cases an increase of density of the hydroxyapatite graft after 6 months and 12 months follow-up was detected. The periimplant region showed in all cases a decrease of density. A progressive decrease of the periimplant and the distant cancellous tibial bone region was also detectable after 6 and 12 months post-op. A similar decrease of density was visible in the region of the cancellous bone of the fibula. In the interface region a direct bone formation between the hydroxyapatite graft and the adjected cancellous bone was visible in all cases during follow-up. CONCLUSION: The increase of density of the hydroxyapatite grafts and the direct bone formation in the interface region between the hydroxyapatite graft and the adjacent cancellous bone are clear radiomorphological signs for an osteointegration of hydroxyapatite grafts in the metaphyseal region.

Adult↗

PubMed1999

[Metastases compromising physical stability].

Multimodal therapy of tumor patients with osseous metastases is an interdisciplinary task. The surgical treatment requires optimal integration, in terms of timing and extent of the procedure, into the overall treatment plan. In addition to surgery, modern therapeutic approaches include systemic chemotherapeutic, hormonal and immunological therapy, radiotherapy, and other drug therapy (i.e. biophosphonates). We use classical stabilization methods with plates and bone cement or intramedullary nailing and also new implants with angular stability like an internal fixator and modular endoprothesis systems in operative therapy. Such stabilizing systems allow bridging of tumor defects in almost all parts of the skeleton. The ultimate goal of any treatment and especially of operative intervention is a mobile patient with little or no pain and a good quality of life.

Bone Neoplasms↗

PubMed1998

[Dorsal removal and stabilization of giant cell tumor of the thoracic spine].

The incidence of giant cell tumors accounts for less than 5% of all bone tumors. In the thoracic spine these tumors are extremely rare (1-1.5% of the giant-cell tumors). The potential malignant character of giant cell tumors of the spine usually leads to wide surgical extirpation by ventral approach. The filling of bone defects with palacos cement after tumor resection is sufficient in the metaphysis of long bones. The case presented here is a giant cell tumor of the upper thoracic spine with primarily posterior destruction of the vertebral body and left arch. A single dorsal approach allowed for intralesional resection and filling of the defect with bone cement. This procedure was sufficient to achieve a solid fixation without recurrence of the giant cell tumor.

Adolescent↗

PubMed1998

[Retrograde intramedullary nailing in proximal fracture of the humerus in the elderly patient. Results of a minimally invasive management concept].

Retrograde intramedullary fixation of proximal humerus fractures with flexible wires was evaluated in a prospectively documented study. Seventy-four fractures in 73 patients with unstable proximal humerus shaft or neck fractures were fixed with 3-11 flexible intramedullary wires. The age of the patients averaged 72 years (42 females, 31 males). In nine fractures additional implants (screws, cerclages) were used to fix dislocated fragments through an anterior approach to the shoulder. Complications associated with the procedure especially in osteoporotic bone were secondary loss of reduction (16%) and wire migration (21%) which lead to revision surgery in 14% of patients within 6 weeks. A minimum follow-up of 12 months (average 16.5 months) could be obtained in 61 patients (84%). According to the Neer- and Constant-scores 60% showed good or excellent results, 30% had a satisfactory and 10% had an unsatisfactory or poor result.--Retrograde intramedullary, flexible wire fixation can provide an overall satisfactory outcome in unstable proximal humerus fractures of the elderly. However, the high incidence of secondary wire dislocations especially in marked osteoporosis appears to be an unsolved problem of this treatment modality.

Aged↗

PubMed1996

Primary extraskeletal mesenchymal chondrosarcoma in fossa poplitea of a 93-year-old woman.

We report the case of a 93-year-old female who had developed a primary extraskeletal chondrosarcoma in Fossa poplitea for many years. This rare, highly malignant tumor occurred in unusual location and at unusual age. Histologically, it presented with sheets of primitive mesenchymal cells and islets of well-differentiated cartilaginous tissue. Immunohistochemical preparations revealed a positivity for neuron-specific enolase and vimentin, the cartilaginous portion of the tumor and isolated cells of the undifferentiated area also stained partially for S-100 protein. Three years later, only one metastasis was found in the contralateral lower extremity.

Aged↗

PubMed1991

The development of osteosarcoma in four-fold selected group of patients.

Patients with osteosarcoma have been submitted to four-fold selection using parameters previously shown to be associated factors. These are sex, age at onset, haptoglobins and histological type. Further data have been added to the final resulting sequence of patients. In the four-fold selected group there is an age-dependent AB0 distribution which confirms the relevance of the criteria used and, consequently, the influence on sarcoma development. It can be assumed from these investigations that the occurrence of osteosarcoma is modified by several genetically fixed factors (HP type, sex, AB0 group).

ABO Blood-Group System↗

PubMed1987

[Malignant bone tumors--definition, epidemiology, symptoms and diagnosis].

An account is given in this paper of incidence and distribution of malignant bone tumours. Reference is made to possible diagnostic approaches, including native X-ray, skeleton scintigraphy, angiography, and computed tomography. Recommendations are, finally, given for diagnostic approaches to suspicious cases of malignant bone tumours.

Bone Neoplasms↗

PubMedDate not supplied

Surgical treatment of bone metastases in breast cancer.

Breast cancer is an osteotropic primary tumor. For the patient metastases to the skeleton imply functional restriction with immobility and pain. Unlike other primary carcinomas breast cancer shows a distinctly longer life expectancy after occurrence of skeletal filiae. LOTE even states a mean survival rate of 4 years. Impending or manifest pathologic fractures as well as pain refractory to medication therapy are indications for operative treatment. As a function of the estimated life expectancy, the number and localisation of metastases and possible adjuvant therapy (hormonal or chemotherapy, radiotherapy) the operative procedure must be chosen. Available options are' intramedullary stabilizing procedures, compound osteosynthesis or endoprothetic means. The objective is the restitution of the weight bearing capacity of the affected skeletal region in addition to pain reduction. This leads to early function and mobility and improves the patient's quality of life.

Bone Cements↗