Importance of lymph node involvement in breast carcinoma for the oncologist

Axillary node status is the most important prognostic information regarding treatment and prognosis for breast cancer patients. Localisation and number of involved lymph nodes add further information and are of prognostic relevance as well. The problem of the involvement of different axilla levels as well as skip metastases are discussed. Sentinel lymph node dissection is still considered investigational as well as axilla downstaging by preoperative chemotherapy. New prognostic markers are helpful in individual situations but are not yet considered as standard procedures. Conclusions of practical relevance are summarised.     

Usefulness of chosen websites concerning diseases of the spine at different stages of the therapy

In the last years a huge increase in the accessibility to the Internet came. At the this paper we are pointing demonstration out websites, mainly English-speaking, which according to our assessment are very well designed conerning content that is published at them as well as the way of presenation of this content. Thanks to these thematic websites it is easier for the sick to find datum about one's diseases, as well as for doctors to reach patients, both with the information and with the therapeutic offer.     

Der Stellenwert der Lymphknotenchirurgie beim Peniskarzinom

Inguinal lymphadenectomy is performed according to the clinical features as well as the risk factors of the primary tumor. In cases involving more than two positive lymph nodes or extranodal growth as well as positive imaging, pelvic lymphadenectomy is indicated. Large or fixed inguinal nodes as well as iliac lymph nodes seen on computed tomography scanning are a good indication for neoadjuvant rather than adjuvant chemotherapy.     

Office workplace at a computer monitor from an occupational-orthopedic view

Typical back problems as well as complaints in the shoulder-arm-hand system are increasing as the volume of sedentary office work at the computer screen rises. Various legal rules precisely define preventive measures. However, basic orthopedic-biomechanical principles are not being taken into consideration.Orthopedists as well as occupational physicians are equally challenged to enforce those legal guidelines by beginning to raise awareness of the principles and thus contributing towards improvement of working conditions.     

Surgical treatment of degenerative osteoarthritis of the fingers

Degenerative osteoarthritis of the long fingers is rare and surgical management is often necessary if there is joint pain, however this indication should not only be based on radiographic imaging. The specific anatomical problems of the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints are described. The surgical approach for each joint is described as well as functional management, in particular that of the extensor apparatus. Mobility should always be preserved for the MCP, arthroplasties are recommended for the PIP except for the index, and arthrodesis for the DIP. The different and most frequently used implants are described as well as the indications and expected results. The indications are discussed in relation to the limited results in the literature as well as the preferences of a panel of French hand surgeons.     

Optimierung des mikrobiologischen und histologischen Status der humanen Allografts

Vascular infections are still associated with high mortality and morbidity rates. Several therapy concepts, such as extraanatomical bypass or in situ reconstruction with silver coated or antibiotic-bonded grafts have been proposed. However, they are associated with considerable complication rates with respect to mortality, reinfection and antibiotic resistance. Alternatively, autologous veins or cryopreserved arterial human allografts (homografts) have been proposed. Despite theoretical advantages of autologous materials, the trauma related to harvesting as well as wound infections and edema remain considerable complications. Thus, homografts have been described as efficient alternatives. However, homograft-related complications (e.g. degeneration, calcification and reinfection) have been well described. Long-term function of homografts is determined by the microbiological status of homografts before implantation, the contribution of cryopreservation to their histological status as well as to a possible immunological reaction of the recipient. In the present review, the in vitro procedures for the optimization as well as their relationship to the improvement of clinical outcomes over the previous years are described.     

Endophytes and associated marine derived fungi—ecological and chemical perspectives

The potential of endophytes and algal or invertebrate associated marine derived fungi as promising sources of structurally unprecedented bioactive natural products is undeniable and continues to attract broad attention. This review highlights new bioactive fungal metabolites reported in 2011 until April 2012, as well as known compounds for which novel biological activities have been disclosed. All compounds are grouped according to their reported biological activities which include cytotoxic, anti-infective, as well as radical scavenging, enzyme inhibition, anti-fouling and anti-parasitic activities. Overall, 178 fungal metabolites, including 138 new natural products are presented. Furthermore, new insights into fungal-host interaction, chemical communication, and chemo-ecological roles of fungal metabolites, as well as new strategies for bioprospecting are presented.     

Pregnancy and chronic kidney disease

This article reviews the association of chronic renal disease and pregnancy. Included are discussions of guidelines for counseling pregnant women with underlying chronic renal disease who are considering conceiving as well as management of those already pregnant. Specifically highlighted are recent studies that question the validity of using estimated glomerular filtration rate and other formulae and questions of whether we should strive to replace the classic counseling approaches based primarily on serum creatinine levels with guidelines based on chronic kidney disease classification. The article concludes with a review as well as a critique of recent research on the prevalence of preeclampsia in women with underlying chronic renal disease, as well as if women with preeclampsia and underlying kidney disease have accelerated courses toward end-stage renal disease.     

慢性前列腺炎诊治中值得关注的几点问题

慢性前列腺炎是泌尿外科最常见的疾病之一,患病率高．治愈率低,易于复发。世界各地报道患病率不同,患暂症状多变。目前,该病病因不明,发病机制不清．缺乏大家公认的诊断标准,治疗方案与疗效判断也存在争议。正确对待慢性前列腺炎．不仅是患者的事情．而且对泌尿外科医生也至关重要。     

Bone architecture and fracture

Bones are designed to carry out their requirements effectively. One of these requirements is to resist fracture. Two other important requirements are to be stiff and to be light. Few theories of adaptive modeling distinguish modeling for adequate stiffness from modeling for adequate strength. Bones achieve their architecture partially through genetics, the rough form of the bone being laid down in the genes, and partially through response to normal loading. Normal loading rarely includes traumatic loading and bones are not usually well adapted to resist trauma, though they are probably well adapted to fatigue loading. Some aspects of architectural function, such as hollowness, are well understood. Some aspects, such as the need for uniform loading in impact, are less understood, and some, such as size effects, are only now beginning to be investigated.     

Vermeidung von Komplikationen bei der Mammareduktionsplastik

A desirable outcome in breast reduction mammoplasty includes unobtrusive scars, stable projection, reliable long-term results and unimpaired sensitivity in the nipple-areola complex (NAC). A breast surgeon should be aware of possible surgical complications and their causes in order to avoid them. Sound knowledge of the anatomy as well as a highly standardized and easily reproducible surgical technique are mandatory for qualitatively uniform results, low complication rates and satisfied patients. Therefore, pre- and intraoperative measures to avoid complications, as well as surgical steps tailored to individual patient needs are helpful. Complications cannot always be avoided and are an integral part of the general surgical risk profile. Hence, knowledge of possible complications and strategies to avoid them, as well as a treatment plan once they occur, provide a high standard of quality in plastic breast surgery.     

Propofol-related myoclonic seizures

Propofol is a popular agent for induction and maintenance of anaesthesia, as well as an excellent sedative agent widely used in ambulatory anaesthesia. Although involuntary movements due to propofol are well known, the occurrence of propofol-related seizure activity in patients with no previous history of epilepsy is less well highlighted. These seizures may occur at all stages of anaesthesia: induction, maintenance, emergence as well as early and late recovery. The cause of these seizures is as yet unknown. The occurrence of seizures with propofol may raise cautions on its use, especially in ambulatory anaesthesia.     

Substances of abuse consumption among patients seeking medical help for uro-andrological purposes:a sociobehavioral survey in the real-life scenario

Substances of abuse(SoA),as well as smoking and alcohol consumption,are well known for their impact on male fertility status,erectile function,and ejaculation.W...     

Propofol-related myoclonic seizures

Propofol is a popular agent for induction and maintenance of anaesthesia, as well as an excellent sedative agent widely used in ambulatory anaesthesia. Although involuntary movements due to propofol are well known, the occurrence of propofol-related seizure activity in patients with no previous history of epilepsy is less well highlighted. These seizures may occur at all stages of anaesthesia: induction, maintenance, emergence as well as early and late recovery. The cause of these seizures is as yet unknown. The occurrence of seizures with propofol may raise cautions on its use, especially in ambulatory anaesthesia.     

Limb-saving resection procedures in primary malignant bone tumors

Thoroughly indicated and performed limb salvaging resections of primary malignant bone tumors can be as well affective as amputations and disarticulations. Possible limb salvaging operative procedures are described with regard to histodiagnosis grading, localisation, expansion of neoplasma as well as to the personality of the patient.     

Digital Ulcers in Systemic Sclerosis

Digital ulcers (DU) are one of the most common complication of Systemic Sclerosis (SSc)-related vasculopathy and represent an important burden for the patients as well as for the society. Still today there is no agreement on the definition, classification and cathegorization of DU even if they are of pivotal importance in clinical practice, for treatment choice and prognostic outcomes, as well as for clinical trials. DU management requires a dedicated multidisciplinary team, that must remain ever vigilant for the development of infective complications and gangrene throughout their disease course, as well as patient education that is crucial to obtain the best compliance to assure the success of the treatment. Currently several drugs are available for DU treatment but in the future, more investigations will be needed to ameliorate the approach and the systemic and local therapies.     

Foot dislocation in the child

Fibulotalar distortions of the ankle are differentiated from distortions with and without instability, as well as instabilities with and without decompensation. Physiological lateral tilting of the talus is shown to be dependent on age and sex as well as on the kind of ligament lesion--avulsion or rupture--likewise dependent on age. The factors involved in the early or late prognosis are discussed. A prospective study is introduced, which differentiated is between primary and secondary distortions or more. Primary distortions (without an osseal lesion) are treated conservatively. Secondary additional distortions with no case history of compensation for the instability are treated operatively, as are avulsions with displaced osseal fragments.     

Soft tissue expanders in hand reconstruction

Eight cases in which soft tissue expanders have been used as an adjunct to reconstruction in the hand are reported. Cases involved reconstruction after skin grafting for burns and crush injuries as well as skin resurfacing in the management of the painful hand. Patient tolerance was excellent and the final result was significantly aided by the use of this technique. The technical details of expansion as well as complications are discussed.     

Editorial Commentary: Meniscal Repair,When Possible,Is Better for Patients Than Meniscectomy

Patients do not do as well after meniscectomy as after repair. Although saving the meniscus is not always easy and the success rate of repair is not 100%, repair—when possible—remains the best option for patients in the long run. Meniscal repair rates are on the rise, especially in younger patients, but are not high enough. Recent research has shown that more than 95% of meniscal procedures are partial meniscectomies. Improved surgical techniques and instrumentation, as well as a continued increase in understanding the importance of repair, are leading to an increase in meniscal repair rates. Preserve as much meniscus as possible and as often as possible.