Zur konservativen Therapie der Unterarmfraktur im Wachstumsalter mit besonderer Berücksichtigung der Korrelation von röntgenologischem Verlauf,objektivem und subjektivem Gesamtergebnis

143 out of 310 patients in the age of one to 18 years suffering from forearm-shaft-fractures could be followed up at the 2nd Department of Traumatology University of Vienna, out of a period between 1978 and 1983. A correlation between radiologic follow-ups and objective/subjective findings was achived by means of the WAMASTAT/SAS program at the Institute of Medical Computer Sciences. With the aid of computer diagrams of the angulation of fracture-dislocation awaited restrictions of movement can be anticipated. Corrective reductions performed in time can prevent disalignment and improve long-term follow-up results.     

Hüfttumorprothese-Indikation in einem unfallchirurgischen Schwerpunktkrankenhaus und Ergebnisse

This is a report about six cases of replacement of the proximal femur by a cementless special prosthesis in modular system done in the Unfallkrankenhaus Wien-Meidling. One of the patients suffered by a lymphoma, three others had fractures caused by bone metastasis. One was a pertrochanteric fracture complicated by osteoporosis, and finally one fracture of the femur preceded by an insufficient implantation of a semitotal hip replacement. The hipsocket was supplied four times by a cementfree Polyäthylensocket, in one case a CLW-ring was implanted. Investigation showed that after a little more than two months the stump of femur became porous and by an average of eleven months the prosthesis was covered by bone. The complications were in one case an incomplete fracture of the diaphysis and in another case a luxation for three times. There are several indications for a tumor prosthesis: 1. Primary and secondary malignant tumors. 2. Bone metastasis with or without fractures. 3. Comminuted fractures complicated by various factors, e. g. osteoporosis. 4. Loosening of prosthesis with poor bone conditions or failed implantation of a standard prosthesis. Although the successes seem to be quite promisingly, this method should be applied in a quite differentiated way, as any retreat is nearly impossible, once started.     

Überlegungen zum Kongreß “Medikamentöse Schmerztherapie” in Berlin

Ohne Zusammenfassung     

HEPATOCELLULAR CARCINOMA PRESENTING AS A SEPTICAEMIA-LIKE ILLNESS IN AN AFRICAN ADOLESCENT

SUMMARY Although primary hepatocellular carcinoma (PHC) is quite common in adults in Africa, it is very rare in those under 25. The clinical diagnosis is usually straightforward by the time patients present and it is unusual to encounter differential diagnostic problems. We report an unusual clinical manifestation of PHC at the very young age of 15 years. The case presented clinically as a septicaemia-like illness that was initially thought to be typhoid. The patient died within 72h of presentation and the true diagnosis was only made at post-mortem. This case simultaneously highlights several problems commonly encountered in medicine in the developing world: late presentation, self-medication, and investigative and diagnostic difficulties related to inadequate facilities.     

Heterogeneity of the T-cell receptor delta gene indicating subclone formation in acute precursor B-cell leukemias

Precursor B-cell acute lymphoblastic leukemias (B-ALLs) have been shown to be oligoclonal at the Ig heavy-chain (IgH) gene level in up to 40% of cases by Southern blot hybridization. In contrast, oligoclonality as deduced from diversity of T-cell receptor (TcR)-delta gene rearrangements of the immature types (ie, V delta 2-D delta 3, D delta 2-D delta 3) has not been reported, so far. We detected oligoclonality characterized by the coexistence of different junctional regions of identical V delta 2-D delta 3 rearrangements in four childhood precursor B-ALLs. No variation was found in the IgH gene status. Therefore, we define these populations as subclones. Two leukemias displayed the variants in an unequal proportion. In the other two leukemias, for which similar quantities of the coexisting rearrangements were detected, single cell-nuclei polymerase chain reaction (PCR) showed two separate leukemic populations. Subclone formation could not be demonstrated by Southern blot hybridization, but was detectable after PCR amplification of the V delta 2-D delta 3 rearrangement and separation by polyacrylamide gel electrophoresis. The variants arose independently from each other, as deduced from their individual sequences. Using subclone-specific oligonucleotides for hybridization to amplified DNA obtained at diagnosis and during follow- up from bone marrow samples, we demonstrate, (1) specificity of all subclone-deduced probes, (2) that one residual leukemic cell can be detected in 10(4) to 10(5) normal mononuclear cells in a semiquantitative assay, and (3) that none of the subclones persisted after induction therapy. We propose that in a leukemic cell population, TcR-delta gene diversity arises after rearrangements of the IgH genes resulting in apparent clonality at the IgH gene level. However, cells are oligoclonal, if the TcR-delta gene rearrangements are considered. As various subclones may respond differently to chemotherapy, they may hamper the detection of minimal residual disease. Therefore, we use all subclone-specific oligonucleotides for hybridization to amplified DNA from follow-up samples.     

Contemporary surgical treatment of primary hyperparathyroidism without intraoperative parathyroid hormone measurement

Introduction

Primary hyperparathyroidism (pHPT) is usually the result of a single adenoma that can often be accurately located preoperatively and excised by a focused operation. Intraoperative parathyroid hormone (IOPTH) measurement is used occasionally to detect additional abnormal glands. However, it remains controversial as to whether IOPTH monitoring is necessary. This study presents the results of a large series of focused parathyroidectomy without IOPTH measurement.

Methods

Data from 2003 to 2014 were collected on 180 consecutive patients who underwent surgical treatment for pHPT by a single surgeon. Preoperative ultrasonography and sestamibi imaging was performed routinely, with computed tomography (CT) and/or selective venous sampling in selected cases. The preferred procedure for single gland disease was a focused lateral approach guided by on-table surgeon performed ultrasonography. Frozen section was used selectively and surgical cure was defined as normocalcaemia at the six-month follow-up appointment.

Results

Focused surgery was undertaken in 146 patients (81%) and 97% of these cases had concordant results with two imaging modalities. In all cases, an abnormal gland was discovered at the predetermined site. Of the 146 patients, 132 underwent a focused lateral approach (11 of which were converted to a collar incision), 10 required a collar incision and 4 underwent a mini-sternotomy. At 6 months following surgery, 142 patients were normocalcaemic (97% primary cure rate). Three of the four treatment failures had subsequent surgery and are now biochemically cured. There were no complications or cases of persistent hypocalcaemia.

Conclusions

This study provides further evidence that in the presence of concordant preoperative imaging, IOPTH measurement can be safely omitted when performing focused parathyroidectomy for most cases of pHPT.