Giant-cell tumors of long bones.
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Bone Neoplasms↗
Biomedical subjects
M Dominkus
Publications and source records attributed to M Dominkus.
Expression of the C5a receptor (CD88) on synovial mast cells in patients with rheumatoid arthritis.
OBJECTIVE: To analyze the immunophenotype and functional properties of synovial mast cells (SyMC) in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). METHODS: Synovial tissue was obtained from 25 patients with RA and 17 patients with OA. Tissue was dispersed by enzymatic digestion using collagenase. Surface receptor expression on SyMC was analyzed by monoclonal antibodies (MAb) and indirect immunofluorescence staining. Histamine release experiments were performed using the MC agonist recombinant human (rHu) stem cell factor (SCF), the anaphylatoxin rHuC5a, and an anti-IgE antibody. RESULTS: In both groups of patients (RA and OA), SyMC were found to react with MAb to IgE, SCF receptor (c-kit, CD117), as well as CD antigens likewise expressed in lung MC (CD9, CD29, CD33, CD43, CD44, CD45). However, a significantly increased proportion of SyMC from RA patients reacted with MAb against C5a receptor (C5aR; CD88), compared with SyMC from OA (mean +/- SD percentage of SyMC reacting with CD88 MAb S5/1 in RA 27.5 +/- 8.6% versus 0.0% in OA, and with CD88 MAb W17/1 in RA 58.3 +/- 15.2% versus 12.5 +/- 15.0% in OA; P < 0.05). Furthermore, in RA, significant histamine release from SyMC above control was induced by rHuC5a, anti-IgE, and rHuSCF, whereas SyMC in OA released histamine after stimulation with anti-IgE and rHuSCF, but not rHuC5a. CONCLUSION: SyMC exhibit phenotypic and functional properties similar to MC in other tissues. In patients with RA, but not OA, SyMC express significant amounts of C5aR (CD88) and release histamine in response to rHuC5a. These results indicate a role for SyMC and C5a/C5aR in the pathogenesis of RA.
Adult↗
[Analysis of acetabulum migration in rheumatoid arthritis compared with cementless acetabular revision].
In a retrospective analysis the migration profile of 73 cementless total hip implants (Zweymüller Alloclassic) in 54 patients with rheumatoid arthritis were compared with the results of 58 implants of the same design in 50 patients undergoing cementless revision after loosening of an Endler cup. 258 conventional radiographs of the rheumatoid patients and 164 radiographs of the revision group were digitized. The migration analysis was performed using a modified Dickob's technique that allows for correction of different X-ray magnifications as well as horizontal and vertical tilting of the pelvis. The analysis of migration exceeded 2 mm in eight rheumatoid patients. In three of them clinical loosening of the acetabular cup was obvious. In the group of patients after cup revision a significantly higher amount of cranial migration was detected compared with the rheumatoid patients. This phenomenon could be explained by the destruction of the weight-bearing cranial acetabular sclerosis after reaming.
Acetabulum↗
[Primary malignant bone tumors. Clinical aspects and therapy. Vienna Bone Tumor Registry].
Diagnosis, concepts of therapy and prognosis of primary malignant bone tumors require intensive cooperation between orthopedic surgeons, radiologists and pathologists with special knowledge in oncology. The present paper demonstrates relevant topics of diagnosis, radiological appearance and therapy of the osteosarcoma, Ewing's sarcoma, chondrosarcoma and malignant fibrous histiocytoma based on the material of the Vienna Bone Tumor Registry and more than 35 years of cooperation between the Institute of Pathology and Anatomy and the Department of Orthopedics at the University of Vienna.
Bone Neoplasms↗
[Pitfalls in MRI diagnosis of primary malignant bone tumors].
MRI has gained an undisputed place in the evaluation of malignant bone tumors, not only for verifying results of conventional radiographs and clarifying differential diagnoses; it has also become increasingly important for the assessment of the malignant/benign nature of the tumor, its growth rate, definition of adequate sites for biopsy, local preoperative staging, and evaluation of the response to chemotherapy. However, several pitfalls have to be observed regarding choice of technical parameters (coils, sequences, imaging planes), tissue differentiation, and tumor staging. When staging malignant tumors, critical aspects which have to be observed are tumor extension, integrity of the cortical bone, soft tissue components, infiltration of a joint or neurovascular bundle. The use of contrast agents provides important additional information but can also give rise to misinterpretations. Thus, all features of a tumor have to be observed in order to establish a final diagnosis. Particular difficulties can occur with the interpretation of MR images of osteomyelitis, osteoid osteoma, stress and insufficiency fractures, bone infarcts, myositis ossificans, hemangiomas, and aneurysmal bone cysts.
Bone Cysts↗
[Surgical therapy of spinal metastases].
Bone metastases of the vertebral spine occur frequently after breast cancer, hypernephroma or thyroid carcinoma. Located commonly in the lumbar and thoracic spine, half of the lesions are found in the vertebral body, but in many cases lamina and pedicles are also involved. Pain resistant to conservative treatment, vertebral compression fracture and segmental instability, together with progredient neurologic deficits and para- or tetraplegia, all make operative intervention mandatory. In this article dorsal decompression and stabilization are compared to ventral decompression and compound osteosynthesis. Segmental stability and life-time prognosis of the patient are important factors to decide on the best surgical procedure. Dorsal decompression without stabilization should only be performed as a palliative procedure in patients with an inoperative tumor, poor prognosis, or if the estimated postoperative segmental stability seems to be sufficient. In cases of a solitary metastasis, after radical resection of the primary tumor and when the prognosis is good total vertebrectomy can be performed. In addition to surgical treatment, adjuvant chemotherapy and/or radiation therapy should be performed in a multidisciplinary setting.
Bone Plates↗
Different cup migration in rheumatoid arthritis and arthrosis: a radiographic analysis of 127 uncemented acetabular cups.
We compared retrospectively the radiographic migration profiles of 82 acetabular components in 61 patients having rheumatoid arthritis with those of 45 hips having arthrosis who underwent a standardized technique of cementless arthroplasty with the Zweymüller prosthesis (Alloclassic). We used a modification of Dickob's technique of digital migration analysis that corrects for magnification errors and horizontal pelvic tilt. The rheumatoid patients were stratified as having oligoarticular, polyarticular, or mutilating arthritis. The overall rate of acetabular loosening in rheumatoid hips after mean 88 (26-117) months was 4%. Loosening was seen only in cases with mutilating arthritis and acetabular protrusion, where the direction of cup migration was also clearly different from that detected in the other types of rheumatoid arthritis and in arthrosis. The different patterns of cup migration in cementless hip replacement for rheumatoid arthritis, depending on disease severity, is of importance when comparing outcome of total hip arthroplasty in rheumatoid patients.
Adult↗
[MR imaging in gout].
The appearance of gouty tophus in magnetic resonance imaging (MRI) is characteristic. On T1- and T2-weighted SE images, the signal intensity of tophaceous lesions is similar to that of muscles. According to the histology, T2-weighted SE images demonstrate extremely hyperintense signals, which reflect the high protein content in the amorphous center of the tophus. The microscopic urate crystals deposited there have no MRI signal and are of no further diagnostic impact. Vascularized granulation tissue surrounding the tophus center enhance after intervenous application of contrast agents (Gadolinium). The inflamed tophus is associated with local edema, causing high signal intensity. MRI is superior to plain radiography for early detection of intraosseous tophi. Involvement of anatomical structures such as ligaments and tendons can be evaluated sufficiently. For peripheral joints, axial slice orientation is most helpful.
Adult↗
Comparison of tissue and plasma levels of ibuprofen after oral and topical administration.
The penetration and absorption of ibuprofen (CAS 15687-27-1) from a topical gel and oral tablets were tested in an open study, performed in 17 patients with degenerative knee disorders requiring an operation. Patients administered the topical test preparation (ibugel, 3 x 375 mg ibuprofen daily) or the standard oral preparation (2 x 600 mg ibuprofen daily) for 3 days prior to the operation. Samples of blood, synovial fluid, muscle, fasciae and subcutis were obtained during the operation (15 h after the last administration) and analysed for ibuprofen content using a validated HPLC method. Different absorption profiles were observed for topical and oral administration. Oral administration led to higher concentrations in the plasma, synovial fluid and fasciae, while higher levels in the muscle and subcutis were found after topical administration. After topical application, the concentrations in the fasciae, muscle and subcutis were significantly higher than those in the blood plasma and synovial fluid (p < 0.05). Very low levels of ibuprofen were observed in the subcutis after oral administration. This can be explained by the different pathways. This study demonstrated that concentrations of ibuprofen in the various biological samples were still within therapeutically effective levels 15 h after topical or oral administration. By use of an oral comparison group, it has been possible to show that the concentrations in times directly under the site of topical application lie in the same order of magnitude as those found after preoral treatment. Therapy of intra-articular inflammatory and degenerative joint diseases requires oral administration of non-steroidal anti-inflammatory drugs (NSAIDs). However, based on the results of this study, topical therapy with NSAIDs can be recommended for soft tissue rheumatism and periarticular insertion tendinopathia.
Administration, Oral↗
Monitoring of patients with rheumatoid arthritis in longterm administration of D-penicillamine.
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Aged↗
Stimulation single fiber EMG study in patients receiving a long-term D-penicillamine treatment for rheumatoid arthritis.
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Adult↗
Percutaneous radiofrequency thermolesion of the sympathetic chain in the treatment of peripheral vascular disease.
Percutaneous radiofrequency thermal lesion of the lumbar sympathetic chain (PRFS) was performed in 30 patients with diabetes mellitus suffering from unreconstractable endstage peripheral vascular disease. All of the patients had the feeling of warmth after PRFS, 45% were free of further complaints and 63% changed to stage II according fontaine. The reported data demonstrate a good comparability concerning amputation after a period of two years to the results obtained by surgical sympathectomy. As there is no need of general anesthesia PRFS turned out to be a good alternative to the surgical sympathectomy.
Adult↗
Transcranial electrical motor evoked potentials as a prognostic indicator for motor recovery in stroke patients.
Transcranial electrical motor evoked potentials (MEP) were examined in 33 patients within three days after stroke. Normal values for MEP and motor central conduction time (CCT) were obtained in 46 healthy controls whose MEPs were evaluated during slight voluntary muscle contraction and at rest. Two months later 23 patients were re-examined clinically and electrophysiologically. Motor function change was correlated with MEP results. Two months after stroke the patients with normal or prolonged CCT had an improved motor function compared with those with absent CCT. MEP may be a valuable prognostic indicator in the acute stage of paralytic stroke for recovery of motor function.
Adult↗
[Percutaneous radio-frequency sympathetic block in peripheral circulatory disorders].
Thirty patients with inoperable diabetic angiopathies (degree III and IV concerning to Fontaine) were treated by means of percutanous radiofrequency thermolesion of the lumbar sympathetic chain (PRFS). All patients reported immediately after this procedure a distinct feeling of warmth in the treated leg. After a period of 6 month to two years 22 patients were re-examined clinically: Fifteen patients changed to Fontaine IIa and ten patients were free of further complaints. Also an improved wound healing and ulcer demarcation following amputation or skin transplantation was observed. The advantage of PRFS in comparison to the surgical sympathectomy is the fact that there is no general anesthesia necessary, which too minimizes the risk especially for the aged vascular patient. Moreover the patient can be mobilised immediately after the procedure. There were no complications like lesion of the ureter or the genitofemoral nerve as well as bleading into the psoas muscle as reported in percutanous chemical lesion of the sympathetic chain.
Adult↗
[Differential behavior of skin temperature in vascular patients vs. pain patients in lumbar radicular stimulation and nerve block].
Plantar skin temperature monitoring during the procedure of percutaneous radiofrequency-thermolesion of the sympathetic chain (PRFS) in patients with vascular diseases and patients with lumbar radicular pain and signs of sympathetic irritation showed a distinct difference. A significant decrease of skin temperature was observed during stimulation of the sympathetic chain by means of canula placement and contrast medium instillation only in the group of "vascular" patients, while "radicular pain" patients showed a significant increase of skin temperature after PRFS. This observation leads to the conclusion that the effect of sympathectomy more or less is to prevent physiological hyperactivity of the sympathetic system.
Adult↗
[Osteosarcoma and Ewing's sarcoma--The most frequent malignant bone tumors in children--therapy and outcome].
BACKGROUND: Osteosarcoma and Ewing's sarcoma are the most frequent malignant bone tumors in children and young adults with relatively poor overall survival rates. METHODS: Between January 1980 and December 1994, 175 children with osteosarcoma and 64 children with Ewing's sarcoma were treated at the author's institution. 22 children had synchronous metastases, 19 patients had a pathologic fracture. Both groups were treated systemically with chemotherapy regimens (COSS and CESS). Local therapy was amputation or tumor resection and endoprosthetic replacement or biological reconstruction with wide or radical resection margins. In case of Ewing's sarcoma in 35 patients postoperative radiation therapy was done. RESULTS: Five-year overall survival rate for osteosarcoma and Ewing's sarcoma patients is about 63 %, ten-year survival rate for osteosarcoma patients is 60.2 %, for Ewing's sarcoma patients 54.5 %. Prognostic factors significantly influencing overall survival rates are tumor response to chemotherapy (p values = 0.0056 and 0.013, respectively), surgical treatment with adequate resection margins (p value = 0.0001 for osteosarcoma patients) and development of postoperative metastases (p value = 0.0001 for both groups). CONCLUSION: For both groups of malignant bone tumors systemic chemotherapy as well as adequate surgical therapy are necessary to reduce the rates of local recurrences and to achieve better survival rates.
Adolescent↗
[Surgical treatment of osteoid osteoma of the extremities].
AIM: It was the aim of this retrospective study to evaluate the frequency of recurrences and complications in patients treated by conventional surgical methods at our institution between 1980 and 1996 and to compare them to those observed in patients treated by minimal invasive methods reported in the literature. METHOD: 70 patients with osteoid osteomas located at the extremities were treated by conventional surgical treatment. 51 patients underwent curettage and 19 patients had en bloc resection. After curettage an additional stabilising plate was implanted in 12% of the cases, after en bloc resection in 68%. RESULTS: There are 66% event-free patients after curettage versus 47% after en bloc resection. Local recurrence rate after curettage was 7%, after en bloc resection no patient developed a recurrence. In both groups a postoperative fracture was observed. Persistent pain due to the implant was reported by 7% after curettage and by 24% after en bloc resection. CONCLUSION: The rate of complications rises with increasing invasiveness and it is necessary to balance the security concerning a local recurrence and the danger of persistent postoperative pain. Curettage is the surgical method of choice in the therapy of the osteoid osteoma, en bloc resection is justified only for recurrent lesions. Curettage is an alternative to minimal invasive methods in cases of superficially located osteoid osteomas or in cases of unfavourable locations of the nidus (near joint or growth plate, inaccessibility).
Austria↗
[Early weight bearing after uncemented total hip prostheses--an analysis of acetabulum cup migration].
PURPOSE: The postoperative mobilisation after cementless total hip arthroplasty is usually non-weight bearing within the first six weeks to achieve bony ingrowth for the implant. Since 1995 weight bearing mobilisation is performed at our clinic even after cementless implantation of the Alloclassic (Zweymüller-Sulzer) system. The aim of the presented study was the detection of any negative influence of weight bearing mobilisation on the stability of this cementless implant. METHOD: The horizontal and vertical cup migration of 42 cementless acetabular cups (Alloclassic Zweymüller-Sulzer) in 40 patients after weight bearing mobilisation and a minimum follow up of 24 months were analysed by a digital migration analysis. The results were compared to a normative migration profile of the same that was recently established. RESULTS: The migration analysis did not exceed the level of accuracy of 1.3 mm in any patient. The mean horizontal cup migration was 0.3 mm in both groups after 24 months, the mean vertical migration was 0.4 mm in both groups. No significant difference of the acetabular stability was detectable. None of the implants showed radiological signs of loosening or migration. CONCLUSION: The presented data justify an early postoperative weight bearing mobilisation using the cementless Alloclassic threated cup, provided that primary stability of the implant can be achieved.
Acetabulum↗