Periprothetische Femurfraktur nach Knietotalendoprothese

Nowadays an increasing number of periprosthetic femoral fractures are observed after revision knee arthroplasty. A 59-year-old male patient who underwent revision knee arthroplasty fell down in the rehab centre and suffered a periprosthetic femoral fracture. After exact preoperative CT planning and measurement of the ratio and linear dimensions a custom-made implant was produced and engrafted on the prosthesis stem accompanied by open reposition. Postoperatively the patient was mobilized with pain-related weight–bearing, and after 12 weeks osseous consolidation and pain-free full weight-bearing were observed. In situ coupling of an endoprosthesis with a slotted hollow nail represents a valuable treatment option for periprosthetic fractures.     

Adverse impact of hyperferritinemia and transfusion dependency on treatment success in myelodysplastic syndrome

BackgroundMyelodysplastic syndrome (MDS) is characterized by peripheral cytopenias and dysplasia in one or more cell lines in the bone marrow. A significant proportion of patients require blood product support due to symptomatic anemia and/or thrombocytopenia during the course of their disease. This retrospective study was planned to evaluate the transfusion requirement of MDS patients and the role of ferritin in predicting transfusion requirement and response to treatment.MethodsWe retrospectively reviewed the records of 35 MDS patients [median age: 66 (22–84); male/female: 21/14]. The World Health Organization (WHO) criteria was used for disease classification and International Prognostic Scoring System (IPSS) for risk stratification.ResultsA total of 22 patients (62.8%) required transfusions during follow-up. While all the 22 patients received packed red blood cells (PRBCs), only 8 patients (22.9%) required platelet transfusion(s). Although no significant relationship was demonstrated between transfusion dependency and disease progression, patients who responded to disease-specific treatment were exposed to less PRBC transfusions compared to non-responders (p = 0.04). Treatment response was found to be better in patients who had lower serum ferritin levels at diagnosis (p = 0.004). A total of 11 patients were followed for a minimum of 24 months. Transfusion load was not different among these patients with respect to disease subtype, IPSS risk score and treatment protocol in the first and second 12-month interval. Median overall survival of the cohort was 26.3 (0.4–160.3) months and median progression free survival was 24.9 (0.4–160.3) months.ConclusionThe present report underlines the association of baseline hyperferritinemia and transfusion dependency with treatment success in MDS. Even in patients treated with new generation agents, the vicious impact of transfusion load seems to be the tender spot of the MDS puzzle. The prognostic impact of baseline hyperferritinemia should be validated with further studies.     

Use of a monopolar laparoscopic electrosurgical instrument for transoral laryngoscopic removal of a giant fibrovascular polyp of the esophagus inlet

Polysegmented fibrovascular polyps are relatively rare benign neoplasms of the esophagus. They frequently reach giant sizes before patients develop symptoms and a diagnosis is made. Appropriate treatment of these polyps is endoscopic or surgical excision. In this paper we report a case in which an 86-year-old man regurgitated a giant polypoid mass into his mouth that led to dyspnea and dysphagia. The polyp was successfully removed by a transoral approach, by minimally invasive surgery, by use of a monopolar laparoscopic electrosurgical instrument (Valleylab LigaSure Advance? Pistol Grip). The patient was symptom and recurrence-free at 6-month follow-up.     

Giant pyogenic granuloma in a renal transplant patient

Pyogenic granuloma is a common benign skin tumor. However, pyogenic granulomas with immunodeficient patients, especially transplant patients, are infrequent. We present a case report of a renal transplant patient with giant pyogenic granuloma. To the best of our knowledge, there are a few reports of pyogenic granuloma in renal transplant patients. This case report explores clinical and treatment elements for pyogenic granulomas as well as a review of the literature.