[Allogenic hand transplantation. A case report of the first 6 months].
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Amputation, Traumatic↗
Biomedical subjects
W Stock
Publications and source records attributed to W Stock.
Defective expression of the SHP-1 phosphatase in polycythemia vera.
The SHP-1 phosphatase associates with the receptors for erythropoietin, stem cell factor, and interleukin-3, and negatively regulates the mitogenic signals generated during engagement by their respective ligands. The erythroid progenitors of patients with polycythemia vera are hypersensitive to the mitogenic effects of these growth factors despite the fact that the numbers and binding affinities for their receptors are not increased. To determine whether post-receptor signaling defects may account for growth factor-hypersensitivity in polycythemia vera, we determined the expression of SHP-1 in highly purified erythroid progenitors from polycythemia vera patients. Our data demonstrate that in approximately 60% of the patients, expression of SHP-1 in the colony forming unit-erythroid population is diminished. The decreased expression of the protein may result from a transcriptional defect, as suggested by the diminished SHP-1 mRNA expression in the erythroid progenitors of these patients. Studies to determine the level of maturation of polycythemia vera and normal cells indicated that there was no difference between the two at early colony forming unit-erythroid stage of differentiation although polycythemia vera cells showed retarded differentiation kinetics at late colony forming unit-erythroid stage of differentiation. Furthermore, SHP-1 expression in normal colony forming unit-erythroid demonstrated downregulation of mRNA and protein levels during terminal differentiation, suggesting that its function is required for growth control during the early stages of erythropoiesis. These results indicate an important role for SHP-1 in the regulation of normal human erythroid progenitors and suggest that defective expression of the protein may contribute to the pathogenesis of polycythemia vera.
Cell Differentiation↗
[Salmonella enteritidis infected false aneurysm of the superficial femoral artery in an HIV seropositive patient].
In the course of an infection with human immunodeficiency virus, a large variety of complications affecting all organ systems can occur. However, complications affecting the vascular system demanding surgical intervention are rare. In the case presented we report a 67-year-old HIV-seropositive patient who underwent surgery for a huge abscess in the thigh. Intraoperatively unexpectedly we found a mycotic aneurysm of the femoral superficial artery and the causactive bacterium proved to be Salmonella enteritidis. Because of the rising number of HIV-infected patients we suspect that the amount of complications involving the vascular system and demanding surgical intervention will also increase. Therefore, when diagnosing and deciding on therapy for patients with AIDS, the physician must be aware that vascular complications due as a result of HIV infection might occur more frequently in the future.
AIDS-Related Opportunistic Infections↗
[Prognostic factors in perforating diverticulitis of the large intestine].
Morbidity and mortality after emergency procedures in 105 patients with perforated colonic diverticulitis were evaluated in a retrospective study. In different stages of diverticulitis (Hinchey classification: I, 8.6%; II, 14.3%; III, 57.1%; IV, 20.0%) mortality was 12.4%. Preoperative sepsis syndrome with leucopenia and disturbed liver function, cardiac risk factors and obesity were independent prognostic factors in multiple logistic regression. Accompanied by immunosuppression the mortality rate remarkably increased to 33%. The stage of peritonitis showed no influence on the prognosis. In multivariate analysis, surgical procedure (primary resection 12.4%. Hartmann's procedure 61.9%, non-resection procedures 25.7%) showed influence only on increased general complications.
Adult↗
A phase II trial of interleukin-2 in myelodysplastic syndromes.
Patients with myelodysplastic syndromes (MDS) show a decrease in the number and function of natural killer (NK) cells, including lymphokine activated killer (LAK) cell activity. Interleukin-2 (IL-2) stimulates the proliferation and activity of these lymphocytes. Anecdotal clinical experience has shown haematological and cytogenetic improvement in myelodysplasia by low-dose IL-2 treatment. A total of 10 patients with MDS were treated with 1 million units of IL-2 subcutaneously daily for 12 weeks. Even though improvement in CD16+/CD56+ cell numbers was seen in a majority of the patients, the haematological status and transfusion requirements remained unchanged. There was minimal toxicity from this therapy.
Adult↗
[Primary shortening--secondary lengthening. A new treatment concept for reconstruction of extensive soft tissue and bone injuries after 3rd degree open fracture and amputation of the lower leg].
The main problem in major limb replantation--especially of the lower extremity--is an extensive bone- and soft-tissue loss. The traditional replantation concept tries to preserve the initial limb length; only a small shortening is accepted. To avoid a more extensive shortening, often insufficient debridement at the time of replantation is carried out. After successful revascularisation, bone and soft-tissue defects will be reconstructed according to the principles of staged reconstruction. Especially segmental nerve defects of more than one major peripheral nerve and severe skin and muscle loss necessitate extensive secondary grafting procedures. This often leads to a prolonged hospitalisation and a high complication rate. In 1951, Lorenz Böhler described the deliberate extremity shortening as a method of therapy in segmental combined bone-soft-tissue defects of the extremities. No additional surgical procedure were necessary to treat the soft tissue defect. A functional but shortened extremity was the result. With Ilizarov's principle of callus distraction he proved in an extensive experimental and clinical study the possibility to lengthen extremities without functional damage up to 20 cm. A new reconstruction concept--"concept of primary shortening with secondary limb lengthening"--for the treatment of amputation and/or amputation-like injuries was created by combining both principles mentioned above. At the time of replantation (reconstruction), deliberate shortening is carried out in order to reduce soft-tissue and/or bone defect or to enable primary nerve repair. Moreover, the aggressive debridement leads to a reduction of the local complication risk (wound healing disturbance, infection) and the potential systemic complications (crush-syndrome, ischemia-reperfusion-syndrome) after revascularisation of a large tissue bloc. Six to twelve months after replantation, secondary limb lengthening is started using an external or internal (= programmable intramedullary nail) distraction device. Since 1985, twelve patients (six macroamputations and six third-degree open fractures of the lower leg) have been treated using the "concept of primary shortening with secondary limb lengthening". Indications, operative technique, and results are shown and discussed, comparing this new concept to the traditional "concept of staged length-reconstruction" with extensive free tissue reconstruction and secondary nerve grafting.
Adult↗
[Colonic diverticulitis--therapy concepts from the surgical viewpoint].
Colon diverticulitis showed a great variability in kind, intensity and course of disease. Time and surgical procedure are dependent on the stage of diverticulitis (emergency procedure, elective resection, early elective resection). In emergency cases non-resecting procedures should not be performed. Here the Hartmann procedure and in favorable conditions the primary resection should be chosen. Other patients with acute diverticulitis should have early elective resection after short-term medical treatment (5-7 days). Patients with a chronic-recurrent course of disease should have an elective one-sided resection. The surgical principles are mobilization of the splenic flexure as well as the widening of the distal resection limit into the upper rectum to avoid a recurrence.
Colectomy↗
[Diagnosis of diverticulitis in routine practice: progress due to pelvic CT?].
In a retrospective study 243 pelvic CTs in patients with acute sigmoid diverticulitis and elective resections were analyzed. A statistical correlation of radiological and histological findings was performed. The sensitivity of the CT in diagnosing sigmoid diverticulitis was 97.5%; the overall accuracy of the pelvic CT was 97.1% in acute diverticulitis. For the contrast enema the sensitivity was 71.6% and the accuracy rate ranked 71.3%. The pelvic CT in patients with clinical suspicion of acute sigmoid diverticulities is well suited for a primary diagnostic tool and can precisely show the extraluminary extension of the inflammation.
Acute Disease↗
[Varicose and ascending thrombophlebitis--surgical planning for emergency crossectomy by duplex ultrasound].
Ascending thrombophlebitis of the superficial leg veins is known to pass into the deep veins, causing an embolism to develop. Duplex ultrasonography has been shown to be a reliable technique for the evaluation of superficial venous thrombosis. If progression is noted, crossectomy proved to be effective in preventing passage of thrombi into the deep veins.
Female↗
[Early elective surgery of acute uncomplicated sigmoid diverticulitis--a dangerous mistake?].
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Acute Disease↗
[Characteristics of normal cross-sectional anatomy of the skin in high resolution magnetic resonance tomography].
PURPOSE: To characterize human skin qualitatively and quantitatively using high-resolution magnetic resonance tomography (MRT) and to compare skin thickness measurements from MRT and histological specimens. MATERIAL AND METHODS: The skin of 84 persons was examined by use of a 2.5 cm coil in a whole-body tomography (gradient field strength 1.5 T) at a linear resolution of 100 microns. To evaluate the ability to identify various skin structures, following an initial visual description, the signal-noise and contrast-noise ratios were analyzed and the MRT-image compared to the corresponding histological specimen. RESULTS: Using the high-resolution coil, epidermis, dermis and subcutis were discernible. Problem areas included the cheek, distal leg and foot. Reproducible measuring of skin thickness with MRT is possible, but it does not correlate well with conventional histologic measurements.
Adolescent↗
[Functional electromyography analysis of radial replacement operation].
The aim of this electromyographic study was to evaluate the functional result of tendon transfers for radial palsy. Eighteen patients were compared to 16 healthy volunteers. The intramuscular emg of four muscles was recorded in parallel during extension-flexion movements of the wrist and fingers. The data were stored on FM tape and evaluated off-line. Contrary to expectations, transferred flexor muscles revealed only part of their overall emg activity during extension. Therefore, an "extensor quota" (EQ) was calculated for each muscle. It reflects its emg activity during extension as part of its entire emg activity. In non-transferred flexors EQ was low (11-27%). High EQ values (69-91%) were seen in genuine extensors of healthy persons. In only 6 of 18 patients did transferred flexors show an EQ equivalent to genuine extensors (> or = 69%). Best functional results were seen in transferred flexor carpi ulnaris (median EQ 68%). The EQ of transferred pronator teres was low (median 18%) and minor to flexor carpi ulnaris in each patient (P < 0.05). It is concluded that in cases of radial palsy, pronator teres is not suitable for replacing extensor muscles. Superficial flexors of the fingers, however, work in synergy with extensors of the wrist. According to the la reflex connections involved, these muscles should be a good choice for regaining extension of the wrist.
Brachial Plexus↗
[Clinical experiences with a new Wiedemann method of radial replacement operation].
Many modifications of tendon transfers have been described in the treatment of radial nerve palsy. Controversy persists over the muscles of choice to get the best results in motion of wrist and fingers. Patients with radial nerve palsy and treated by the method of Merle d'Aubigne in neurophysiological tests showed that the pronator teres did not work very well for extending the wrist. Thinking about the neurophysiologic principles it seemed that the flexor digitorum superficialis of the middle and ring fingers would make a better substitute for the wrist extension. From 1994 to 1997 four patients with radial nerve palsy had a transfer of the flexor digitorum superficialis tendons from the middle and ring fingers to the tendons of extensor carpi radialis longus and brevis additional the flexor carpi ulnaris and palmaris longus transfers. The functional recovery of two patients has been tested. The functional range of wrist motion of this two patients has been better than in patients with pronator teres transfers. It can be concluded that the new modification of tendon transfers is a good way of treatment of radial nerve palsy and should be done further.
Adult↗
Value of molecular monitoring during the treatment of chronic myeloid leukemia: a Cancer and Leukemia Group B study.
PURPOSE: Disappearance of the Philadelphia chromosome during treatment for chronic myeloid leukemia (CML) has become an important therapeutic end point. To determine the additional value of molecular monitoring during treatment for CML, we performed a prospective, sequential analysis using quantitative Southern blot monitoring of BCR gene rearrangements of blood and marrow samples from Cancer and Leukemia Group B (CALGB) study 8761. PATIENTS AND METHODS: Sixty-four previously untreated adults with chronic-phase CML who were enrolled onto CALGB 8761, a molecular-monitoring companion study to a treatment study for adults with chronic-phase CML (CALGB 9013). Treatment consisted of repetitive cycles of interferon alfa and low-dose subcutaneous cytarabine. Blood and marrow Southern blot quantitation of BCR gene rearrangements was compared with marrow cytogenetic analysis before the initiation of treatment and of specified points during therapy. Reverse-transcriptase polymerase chain reaction (RT-PCR) analysis was performed to detect residual disease in patients who achieved a complete response by Southern blot or cytogenetic analysis. RESULTS: Quantitative molecular monitoring by Southern blot analysis of blood samples was found to be equivalent to marrow monitoring at all time points. Twelve of 62 (19%) follow-up samples studied by Southern blot analysis had a complete loss of BCR gene rearrangement in matched marrow and blood specimens. Southern blot monitoring of blood samples was also found to be highly correlated to marrow cytogenetic evaluation at all points, although there were four discordant cases in which Southern blot analysis of blood showed no BCR gene rearrangement, yet demonstrated from 12% to 20% Philadelphia chromosome-positive metaphase cells in the marrow. RT-PCR analysis detected residual disease in five of six patients in whom no malignant cells were detected using Southern blot or cytogenetic analyses. CONCLUSION: Quantitative Southern blot analysis of blood samples may be substituted for bone marrow to monitor the response to therapy in CML and results in the need for fewer bone marrow examinations. To avoid overestimating the degree of response, marrow cytogenetic analysis should be performed when patients achieve a complete response by Southern blot monitoring. This approach provides a rational, cost-effective strategy to monitor the effect of treatment of individual patients, as well as to analyze large clinical trials in CML.
Adult↗
[Acute compartment syndrome of the tibia--complication of popliteal artery aneurysm].
The compartment syndrome is a common complication in the traumatology of the lower limb. In vascular surgery it is observed following emergency revascularisation. It is a rare condition as an initial symptom of a peripheral clotted aneurysm. By means of a case with a complicated popliteal aneurysm the differential diagnosis of the non-traumatologic compartment syndrome is discussed.
Adult↗
[Value of individually risk-adjusted after-care--economic management of oncologic effectiveness?].
The individual risk-adapted follow-up programme after R0-resection of colorectal carcinoma is a propatiently and favourable alternative. Controlled economic studies are required to examine further quantitative and qualitative modifications of the follow-up programme.
Aftercare↗
Polymerase chain reaction-based diagnosis of del (5q) in acute myeloid leukemia and myelodysplastic syndrome identifies a minimal deletion interval.
Loss of all or part of the long arm of human chromosome 5 is a recurrent abnormality in patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), especially after chemotherapy for a prior malignancy. It is one of the worst prognostic indicators in AML, associated with chemotherapy resistance and short survival. These deletions center at band 5q31, which has thus been proposed as the location of a tumor suppressor gene; this site is to be distinguished from that observed in 5q- syndrome, centering at 5q32. To define the molecular extent and the clinical prevalence of 5q31 deletions, we collected a series of AML and MDS cases of mixed karyotype, taking care to exclude MDS cases with 5q- syndrome. The samples were analyzed for loss of heterozygosity (LOH) using a panel polymerase chain reaction (PCR)-based microsatellite markers from 5q, comparing malignant cells with normal tissue derived from lymphoblastoid cell lines or buccal mucosa scrapings. Losses were detected in seven of 29 matched samples, including four of 17 with MDS, and three of 12 with AML; six of these seven also had a cytogenetically-visible del(5q) or -5. The one case without a cytogenetic deletion showed molecular loss of three contiguous markers, with retention of flanking markers interleukin-9 (IL-9) and D5S414, and thus contained a small deletion that is below cytogenetic resolution. PCR failed to detect 5q loss in two cases with large cytogenetic deletions, but both had been treated and contained low percentages of malignant cells in the samples. This study thus led to the identification of a case with a minimal deletion for the 5q31 tumor suppressor gene, specified by IL-9-D5S414, that is approximately 1 Mb (2 cM) in extent. Additionally, we demonstrate that PCR-based allelotyping is a reliable method for the detection of chromosomal deletion in myeloid malignancy, providing the specimens contain a high proportion of malignant cells. These studies will help to identify the tumor-suppressor gene at 5q31, and will help to develop molecular methods for diagnosis and monitoring of these disorders.
Acute Disease↗
[Palliative surgical treatment of bone metastases. Improved quality of life by early intervention?].
OBJECTIVE: To find out to what extent early operative treatment of osteolysis or pathological fractures, resulting from improved interdisciplinary treatment of malignant tumours, affects quality of life. PATIENTS AND METHOD: Using a standardised scheme of self-evaluation in a retrospective study, quality of life was assessed in 67 patients (18 men, 49 women; mean age 64.5 +/- 11.6 years) who were operated for osteolyses or pathological limb fractures due to malignant tumour metastases. RESULTS: Interlocking osteosynthesis was performed in 37 patients, endoprosthetic joint replacement in 30. Duration of operation and hospital stay were significantly shorter in those 17 patients operated for osteolysis than those 50 patients with a pathological fracture (P < 0.01 and P < 0.07, respectively). There were seven hospital deaths. Postoperative survival time averaged 13.4 months. 41 of the 60 patients discharged to outpatient follow-up were again capable of leading a normal life, 13 were clearly impaired, six required nursing care, 46 patients did not or only sporadically require analgesics postoperatively. CONCLUSION: Early operative treatment of osteolysis before the occurrence of fractures is justified by the low operative mortality and complication rates and the better quality of life that is achieved.
Aged↗