Surgical treatment of osteochondritis dissecans of the talus: a systematic review

Purpose

Osteochondritis dissecans (OCD) is an aseptic bone necrosis and represents pathology of high clinical relevance, which is frequently located on the talus. Various treatment strategies including non-surgical and surgical approaches have been described. An evidence-based treatment algorithm is still lacking. The present systematic review focuses on surgical treatment options and their stage-dependent outcome described for treatment of osteochondritis dissecans of the talus with special regard to the best available evidence.

Methods

For this purpose, an OVID-based systematic literature search was performed including the following databases; MEDLINE, MEDLINE preprints, EMBASE, CINAHL, Life Science Citations, British National Library of Health and Cochrane Central Register of Controlled trials (CENTRAL). Literature search period was from January 1967 up to December 2009. After applying study specific inclusion criteria (minimum follow-up 12?months, patient evaluation by standardized scoring systems, etc.), a total of 54 studies with clinical follow-up of 1,105 patients was included. Methodology of these studies was systematically analyzed by the means of the Coleman Methodology Score. Outcome and success rate was evaluated in dependence of surgical treatment applied and in dependence of the stage of disease.

Results

All 54 studies included were classified as evidence level IV representing case series. The average Coleman Methodology Score was 63 (SD?±?17) points. The average follow-up of the 1,105 patients was 47?months (SD?±?17) with a mean age of 29 (SD?±?5.6)?years. The proportion of excellent and good treatment results was stage-independent in total 75?%. According to the criteria of the score applied for patient’s evaluation in the individual study, the overall percentage of “good” and “excellent” clinical outcome in 869 patients was 79?%, and according the classification of Berndt and Harty, 82?% in stage I, 86?% in stage II, 83?% in stage III and 76?% in stage IV.

Conclusions

Although OCD of the talus represents a frequently observed orthopedic pathology, evidence concerning operative treatment of osteochondrosis dissecans of the talus is still elusive. With over 1,100 included patients in the present study, no strong recommendations based upon scientific evidence can be given.     

Histological analysis of capsule formation around silicone implants and comparison with titanium-coated silicone implants in rats

Silicone implants have been used for breast augmentation for more than 45 years. Complications, in particular capsular contracture, occur with an incidence of <10% and up to 60%. We investigated the influence of the surface of breast implants on the formation of capsular contracture by comparing silicone with titanium-coated silicone. Seventeen smooth saline-filled silicone (group A) and 14 saline-filled titanium-coated silicone (group B) implants were implanted in female Wistar rats. After 12 and 36 weeks, the implants and capsules were extracted; histological and immunohistochemical staining was performed. The evaluation of the capsules was performed by two examiners in a double-blinded manner. Histologically, no significant difference in total capsule thickness was found. There was a significant difference in synovial-like metaplasia layer (SLM) thickness between groups A and B (p = 0.041). Regarding implantation time (12 vs. 36 weeks), a significant difference was found in SLM thickness (p = 0.021). Immunohistochemical staining indicated a significantly lower infiltration with inflammatory cells in group B. A significant correlation (p = 0.019) between a thick SLM layer and inflammatory cell infiltration was detected. Titanium-coated silicone implants reduce SLM thickness and capsular inflammatory cell infiltration. These findings postulate that titanium-coated silicone implants might point out a new chance in the prevention of capsular contracture.     

C-Reactive Protein 2 Days After Laparoscopic Gastric Bypass Surgery Reliably Indicates Leaks and Moderately Predicts Morbidity

Background

The aim of the present study was to evaluate whether serum C-reactive protein (CRP) is a useful predictor of early post-operative complications, particularly of intestinal leaks after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery.

Methods

The present study was a retrospective analysis of a prospectively maintained database with 809 patients who underwent LRYGB from 2002 until 2011. For 410 of these patients, at least one CRP measurement within the first seven post-operative days was available. The diagnostic value was determined by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.

Results

Forty-nine of 410 patients (12.0?%; 95?% confidence intervals [95?% CI], 9.2?C15.5?%) developed surgery-related complications. Leaks occurred in 17 patients (4.1?%; 95?% CI, 2.6?C6.5?%) at a median of 5?days after surgery. CRP levels 2?days after surgery showed the highest diagnostic value for post-operative complications (AUC, 0.74; 95?% CI, 0.60?C0.89). Sensitivity was 0.53 (95?% CI, 0.31?C0.74) and specificity was 0.91 (95?% CI, 0.79?C0.96) on day 2 (cutoff level, 229?mg/l). The sensitivity for intestinal leaks was 1.00 (95?% CI, 0.51?C1.00).

Conclusion

CRP on post-operative day 2 is a valuable predictor of post-operative complications, in particular intestinal leaks. Radiological imaging studies for intestinal leaks could be restricted to patients with CRP values exceeding 229?mg/l.     

Radioembolization of Symptomatic,Unresectable Neuroendocrine Hepatic Metastases Using Yttrium-90 Microspheres

Purpose  

To evaluate safety, efficacy, and symptom-control of radioembolization in patients with unresectable liver metastases from neuroendocrine tumors (NETLMs).     

Microwave Ablation Compared with Radiofrequency Ablation for Breast Tissue in an Ex Vivo Bovine Udder Model

Purpose

To compare the effectiveness of microwave (MW) ablation with radiofrequency (RF) ablation for treating breast tissue in a nonperfused ex vivo model of healthy bovine udder tissue.

Materials and Methods

MW ablations were performed at power outputs of 25W, 35W, and 45W using a 915-MHz frequency generator and a 2-cm active tip antenna. RF ablations were performed with a bipolar RF system with 2- and 3-cm active tip electrodes. Tissue temperatures were continuously monitored during ablation.

Results

The mean short-axis diameters of the coagulation zones were 1.34 ± 0.14, 1.45 ± 0.13, and 1.74 ± 0.11 cm for MW ablation at outputs of 25W, 35W, and 45W. For RF ablation, the corresponding values were 1.16 ± 0.09 and 1.26 ± 0.14 cm with electrodes having 2- and 3-cm active tips, respectively. The mean coagulation volumes were 2.27 ± 0.65, 2.85 ± 0.72, and 4.45 ± 0.47 cm³ for MW ablation at outputs of 25W, 35W, and 45W and 1.18 ± 0.30 and 2.29 ± 0.55 cm³ got RF ablation with 2- and 3-cm electrodes, respectively. MW ablations at 35W and 45W achieved significantly longer short-axis diameters than RF ablations (P < 0.05). The highest tissue temperature was achieved with MW ablation at 45W (P < 0.05). On histological examination, the extent of the ablation zone in MW ablations was less affected by tissue heterogeneity than that in RF ablations.

Conclusion

MW ablation appears to be advantageous with respect to the volume of ablation and the shape of the margin of necrosis compared with RF ablation in an ex vivo bovine udder.     

Transarterial Hepatic Yttrium-90 Radioembolization in Patients with Unresectable Intrahepatic Cholangiocarcinoma: Factors Associated with Prolonged Survival

Introduction

In unresectable intrahepatic cholangiocarcinoma (ICC), systemic chemotherapy often is viewed as the only option, although efficacy is limited. Radioembolization (RE) using yttrium-90 (⁹⁰Y) microspheres is an accepted therapy for patients with hepatocellular-carcinoma or metastatic liver tumors. However, there are limited data on the value of RE in patients with ICC and few data on factors influencing prognosis. The purpose of our retrospective analysis was to establish which factors influenced time-to-progression (TTP) and overall survival (OS).

Methods

Patients with unresectable ICC were treated with ⁹⁰Y resin-microspheres and assessed at 3-monthly intervals. Radiologic response was evaluated by using Response Criteria in Solid Tumors (RECIST). Baseline characteristics, biochemical/clinical toxicities, and response were examined for impact on TTP and OS.

Results

Thirty-four treatments were administered to 33 patients without major complications. By RECIST, 12 patients had a partial response, 17 had stable disease, and 5 had progressive disease after 3?months. The median OS was 22?months posttreatment and 43.7?months postdiagnosis. Median TTP was 9.8?months. Survival and TTP were significantly prolonged in patients with ECOG 0 (vs. ECOG 1 or 2; median OS: 29.4, 10, and 5.1?months; TTP: 17.5, 6.9, and 2.4?months), tumor burden ??25% (OS: 26.7 vs. 6?months; TTP: 17.5 vs. 2.3?months), or tumor response (PR or SD vs. PD; OS: 35.5, 17.7 vs. 5.7?months; TTP: 31.9, 9.8 vs. 2.5?months), respectively (P?<?0.001).

Conclusions

Radioembolization is an effective and safe option for patients with unresectable ICC. Predictors for prolonged survival are performance status, tumor burden, and RECIST response.     

Different gene expression profiles in normo- and dyslipidemic men after fish oil supplementation: results from a randomized controlled trial

ABSTRACT: BACKGROUND: Epidemiological studies have suggested the benefits of omega-3 polyunsaturated fatty acids (n-3 PUFAs) on cardiovascular health, but only limited data are available describing n-3 PUFA regulated pathways in humans. The aim of this study was to investigate the effects of n-3 PUFA administration on whole genome expression profiles in the blood of normo- and dyslipidemic subjects. METHODS: Differentially expressed genes were detected after four hours, one week and twelve weeks of supplementation with either fish oil (FO) or corn oil in normo- and dyslipidemic men using whole genome microarrays. RESULTS: Independent of the oil, a significantly higher number of genes was regulated in dyslipidemic subjects compared to normolipidemic subjects. Pathway analyses discovered metabolisms dominantly affected by FO after twelve weeks of supplementation, including the lipid metabolism, immune system and cardiovascular diseases. Several pro-inflammatory genes, in particular, were down-regulated in dyslipidemic subjects, indicating the immune-modulatory and anti-inflammatory capability of FO and its bioactive FAs, eicosapentaenoic acid and docosahexaenoic acid. CONCLUSIONS: This is the first study showing significant differences in gene expression profiles between normo- and dyslipidemic men after FO supplementation. Further studies need to clarify the exact role of n-3 PUFAs in pathways and metabolisms which were identified as being regulated after FO supplementation in this study.Trial registrationClinicalTrials.gov (ID: NCT01089231).