The influence of partial gastrectomy on biochemical parameters of bone metabolism and bone density

Summary Since it has been suggested that gastric resections are followed by changes in bone metabolism, the aim of our study was to determine the biochemical parameters of bone metabolism and radial and lumbar bone density in 15 male ulcus patients treated by partial gastrectomy (Billroth II). Comparing the data with those of a corresponding control group, the lumbar bone density measured by quantitative computed tomography was statistically significantly lower (P < 0.04) in the patient group, whereas the peripheral bone mass of the distal part of the nondominant forearm measured by single-photon absorptiometry showed no statistically significant difference. In addition, a marked increase in alkaline phosphatase (P < 0.002) and urinary excretion of hydroxyproline (P < 0.003) was found in the gastrectomy group, whereas the 25-hydroxy-vitamin D levels were found to be significantly decreased (P < 0.04). Osteocalcin, a biochemical marker for osteoblast activity, and the carboxy-terminal propeptide of type I procollagen (PICP), a marker of collagen formation, were slightly but not significantly higher in gastrectomy-treated patients. The serum parathyroid hormone levels were similar in both groups. As none of the patients had any radiologic evidence of osteopenia, the changes in biochemical parameters of bone metabolism and bone mass in patients who had undergone partial gastrectomy could be a marker of latent bone loss.Abbreviations DPA/SPA dual/single-photon absorptiometry - BMD bone mineral density - QCT quantitative computed tomography - PICP carboxy-terminal propeptide of type I procollagen - 250HD₃ 25-hydroxy-vitamin D - iPTH parathyroid hormone - OC osteocalcin - BMC bone mineral content     

Recent possibilities for the treatment of osteoporosis in the aged

Treatment of idiopathic osteoporosis in the elderly presupposes exact radiological diagnosis, the exclusion of a primary illness as the cause of the pathological process and exact differential diagnosis from other metabolic osteopathies. We consider possible means of prevention of the immobilization of old people, and appropriate hormonal substitution in cases of previous illnesses which coincide with a disturbance of the gonadal function, as important prophylactic measures. In the case of manifest osteoporosis, if possible, an assignment of the disease to a manifestation with high or low bone turnover should be made, by means of biochemical adjuvants. In high bone turnover, the substitution of sex hormones or the administration of calcitonin is indicated, particularly if symptoms of pain are distinct. In osteoporosis with low bone turnover, fluoride in long-term therapy is the preferred medication. The latest studies show that a combination of fluoride and active vitamin D metabolites is preferable to monotherapy. All therapy for this disease, independent of the age of the patient, should be supported by isometric exercises, analgesics and appropriate dietary measures. Orthopaedic supporting measures should be applied only if conservative measures in acute vertebral fractures fail.     

Rare patients in routine care: Treatment and outcome in advanced papillary renal cell carcinoma in the prospective German clinical RCC-Registry

Non-clear cell renal cell carcinoma is a very rare malignancy that includes several histological subtypes. Each subtype may need to be addressed separately regarding prognosis and treatment; however, no Phase III clinical trial data exist. Thus, treatment recommendations for patients with non-clear cell metastatic RCC (mRCC) remain unclear. We present first prospective data on choice of first- and second-line treatment in routine practice and outcome of patients with papillary mRCC. From the prospective German clinical cohort study (RCC-Registry), 99 patients with papillary mRCC treated with systemic first-line therapy between December 2007 and May 2017 were included. Prospectively enrolled patients who had started first-line treatment until May 15, 2016, were included into the outcome analyses (n = 82). Treatment was similar to therapies used for clear cell mRCC and consisted of tyrosine kinase inhibitors, mechanistic target of rapamycin inhibitors and recently checkpoint inhibitors. Median progression-free survival from start of first-line treatment was 5.4 months (95% confidence interval [CI], 4.1–9.2) and median overall survival was 12.0 months (95% CI, 8.1–20.0). At data cutoff, 73% of the patients died, 6% were still observed, 12% were lost to follow-up, and 9% were alive at the end of the individual 3-year observation period. Despite the lack of prospective Phase III evidence in patients with papillary mRCC, our real-world data reveal effectiveness of systemic clear cell mRCC therapy in papillary mRCC. The prognosis seems to be inferior for papillary compared to clear cell mRCC. Further studies are needed to identify drivers of effectiveness of systemic therapy for papillary mRCC.     

Über den „sekretorischen Mittelohrkatarrh“

Zusammenfassung Der sekretorische Mittelohrkatarrh stellt, was zumeist zu wenig berücksichtigt wird, keine einheitliche Erkrankung dar. In der Mehrzahl der Fälle handelt es sich um eineseröse Entzündung mit Exsudat, serologische Untersuchungen sowie klinische Beobachtungen und Erwägungen sprechen eindringlich dafür, in den anderen Fällen liegt infolge eines Tubenverschlusses durch Tumordruck oder Narbenstriktur einHydrops (Transsudat) vor, wobei nicht feststeht, ob dieser ex vacuo oder durch Stauung zustande kommt. In Fülen von Tumor begünstigt vielleicht die Kachexie die Bildung des Transsudates.Nach Abschluß meiner Arbeit mußte ich feststellen, daß mir bei der Durchsicht des Schrifttums eine Arbeit vonN. Rh. Blegvad, erschienen in der Monatsschrift für Ohrenheilkunde 1932 unter dem Titel Ist der Begriff Tubenokklusion aufrecht zu erhalten ? völlig entgangen war. So sehr ich dieses Versehen bedauere, so sehr hat es mich gefreut, in dieser Arbeit vielfach den gleichen Gedankengängen begegnet zu sein, wie ich sie oben, vollkommen unabhängig davon, entwickelt habe.Herrn ProfessorZange, zum 60. Geburtstag.     

Eine Methode zur Messung des Quellungszustandes der lebenden Haut

Ohne ZusammenfassungMit 5 Textabbildungen.     

Distraction Osteogenesis of Ankylosed Front Teeth with Subsequent Orthodontic Fine Adjustment

OBJECTIVE: Conventional therapeutic approaches to correct ankylosed anterior teeth in infraposition require compromises involving esthetics and function. The combined approach of distraction and early orthodontic fine adjustment, not yet established as a routine, promises better results concerning the bone conditions and gingival development. CASE HISTORIES: Both female patients had suffered a trauma to the front teeth during early mixed dentition resulting in ankylosed central incisors in infraposition. At the ages of 14 years and 2 months and 15 years and 2 months, respectively, we carried out segment distraction by means of a bone-supported internal distractor followed by orthodontic fine adjustment after having shortened the consolidation phase. Both ankylosed front teeth could be successfully aligned, leading to an increase in bone and harmonization of the gingival margin in the dental arch. At ten and 14 months after the conclusion of treatment, we observed only few deviations in the dental situation compared to posttherapeutic findings. CONCLUSION: From a functional and esthetic point of view, therapy involving combined orthodontics and surgery is superior to conventional therapy. Orthodontic fine adjustment should be considered as a continuation of the distraction procedure.     

Editorial

Ohne Zusammenfassung     

Value of ultrasonography in preoperative diagnosis of rotator cuff tears and postoperative follow-up

Four hundred and six patients presenting with shoulder pain underwent bilateral shoulder ultrasonography. Rotator cuff lesions were diagnosed in 197 patients. In 155 of the 308 patients who had additional arthrographic examinations, the arthrogram documented rotator cuff tears. Sixty-eight patients underwent surgery. There was good correlation between the ultrasonographic and arthrographic findings as well as the surgical results, with a sensitivity of 91% for each examination technique. Thirty-six postoperative patients were studied ultrasonographically; a minor to marked increase in rotator cuff echogenicity was demonstrated in them all. Its high predictive value makes ultrasonography the method of choice in diagnosing rotator cuff tears. Based on the evaluation of particular criteria, rotator cuff tears (greater than 1 cm) are commonly documented by ultrasonography. Only in patients with indeterminate or negative ultrasonograms in whom there is a high index of clinical suspicion, should arthrography be performed as a complementary imaging test. In postoperative follow-up the degree of scar formation at the reinsertion of the tendon is adequately documented by ultrasonography.