Versagensgründe von Oberflächenersatzimplantaten der Hüfte

Hip resurfacing has been experiencing a revival over the last 5-10 years. Early failure rates are higher than for conventional primary hip arthroplasty. Fractures of the femoral neck or head, cup loosening and persistent pain are the most frequently observed reasons for early revision. In this international retrospective uncontrolled study, 256 revision specimens (219 resurfacing heads, 37 cups) were analysed radiologically, tribologically, morphologically and histologically in order to investigate the failure mechanism. Of the head revisions, 70% were due to neck (median: 67 days after implantation) and head fractures (161 days), 9% were due to cup loosening (350 days) and 21% due to other reasons (602 days). Implants with rim loading (22% of all retrievals, cup inclination 58.0+/-10.9 degrees ) exhibited a head wear rate of 7.1+/-5.2 mm3/year. Non-rim loaded implants exhibited a head wear rate of 0.24+/-0.53 mm3/year (cup inclination 49.0+/-4.0 degrees ). The failure rate was highest during the first 16 weeks after surgery and for the first ten operations performed by a surgeon. Revisions based on problems on the femoral side such as notching and high implantation forces occurred earlier than revisions based on problems on the acetabular side such as cup loosening and high wear due to suboptimal cup position.     

Recent perspectives on the age-related decline of testosterone

A pivotal question is whether the age-related decline of testosterone should be viewed as hypogonadism, i.e. a deficiency of testosterone manifesting itself by the signs and symptoms of insufficient androgen action and, in the best case, reversed by testosterone treatment. There is no clear dividing line between normal and subnormal blood testosterone levels for establishing with certainty whether a man is hypogonadal or not. Rather, symptoms accumulate gradually with decreasing testosterone level, with these levels of testosterone differing between individuals, while within a subject not all symptoms of testosterone deficiency will manifest themselves at the same blood testosterone level.

The diagnosis of late onset hypogonadism (LOH) and, certainly, the decision to provide androgen treatment must be made with caution, taking the specific increment of symptoms in relation to testosterone levels into account. The various symptoms of LOH might start at various concentrations of androgens. With a given plasma testosterone level, some complaints might be present and others not. This has also been confirmed in studies establishing symptom-specific thresholds of androgen levels.

Symptoms of LOH do not manifest themselves at uniform threshold values of testosterone. Therefore, symptoms of testosterone deficiency are not uniformly and predictably related to blood testosterone values, which may lead to different diagnostic criteria for testosterone deficiency. So, the conclusion seems inevitable that the clinical manifestations of hypogonadism are multifactorially determined and that the diagnosis should not only depend on the measurement of testosterone but a proper assessment should comprise somatic and psychological aspects in addition to measurement of testosterone.     

Physician attitudes to the concept of ‘men''s health’ in Asia

BackgroundMen's health is an emerging medical and public health concept, but it is confronted by special challenges in the Asia-Pacific medical and cultural context.MethodsA telephone survey was conducted with physicians in Korea, Taiwan and Singapore. The interview was conducted in Korean (Korea), Mandarin (Taiwan) or English (Singapore) by trained interviewers. The physicians interviewed were drawn from a variety of medical specialties including urology, primary care, endocrinology and cardiology.ResultsIn total, 810 physicians from various medical specialities took part in the survey. There was only broad general agreement (>50%) between the physicians in the various countries on a range of questions relating to men's health, such as the conditions most associated with men's health, the predictability of illness/disability with age etc, and physician willingness to discuss problems in sexual health.ConclusionsThe data from this survey suggest that, although not as clearly defined as women's health, the treatment of men's health cuts across many different medical specialties and takes in a broad spectrum of health conditions. Therefore, there is a clear opportunity for the medical community to define, refine and improve the treatment and understanding of men's health in Asia.     

Treatment Guidelines for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: When Can We Operate or Observe?

Background The objectives of this study were to investigate the clinicopathological features of branch intraductal papillary mucinous neoplasm (IPMN) and to determine safe criteria for its observation. Most clinicians agree that surgical resection is required to treat main duct-type IPMN because of its high malignancy rate. However, no definite treatment guideline (with respect to surgery or observation) has been issued on the management of branch duct type IPMN. Methods We retrospectively reviewed the clinicopathological data of 138 patients who underwent operations for IPMN between 1993 and 2006 at five institutes in Korea. Results Of 138 patients (mean age, 60.6 years; 87 men, 51 women), 76 underwent pancreatoduodenectomy, 39 distal pancreatectomy, 4 total pancreatectomy, and 20 limited pancreatic resection. There were 112 benign cases: 47 adenoma, 63 borderline cases, and 26 malignant cases, with 9 of these being noninvasive and 17 invasive. By univariate analysis, tumor size and the presence of a mural nodule were identified as meaningful predictors of malignancy. By receiver operating characteristic curve analysis, a tumor size of >2 cm was found to be the most valuable predictor of malignancy. When cases were classified according to tumor size and the presence of a mural nodule, the malignancy rate for a tumor ≤2 cm without a mural nodule was 9.2%, for a tumor of ≤2 cm plus a mural nodule was 25%, and for other conditions such as tumor >2 cm, >25%. Conclusions Many branch duct IPMNs are malignant. Surgical treatment is recommended, except in cases that are strongly suspected to be benign or cases that present a high operative risk. Observation is only recommended in patients with a tumor size of ≤2 cm without a mural nodule.     

The Possible Association between IVF and Breast Cancer Incidence

Background The possible association between ovulation-inducing drugs and breast cancer development has been debated. Our aim was to evaluate the incidence of breast cancer in a cohort of women exposed to in vitro fertilization (IVF). Methods A retrospective cohort analysis was performed by linkage of the computerized database of all women treated at the IVF Unit at Assaf Harofeh Medical Center between 1986 and 2003, and the Israeli National Cancer Registry. The standardized incidence ratio (SIR) was computed as the ratio between the observed number of breast cancer cases and the expected cases, adjusted for age and continent of birth, in the general population. Tumor characteristics of the IVF patients were studied by reviewing original medical records. Results 35 breast carcinomas were diagnosed among 3,375 IVF-treated women, compared to 24.8 cases expected (SIR = 1.4; 95% CI 0.98–1.96). Age ≥40 years at IVF treatment (SIR = 1.9; 95% CI 0.97–3.30), hormonal infertility (SIR = 3.1; 95% CI 0.99–7.22), and ≥4 IVF cycles (SIR = 2.0; 95% CI 1.15–3.27) were found to be risk factors to develop breast cancer compared to the general population. Multivariate analysis revealed that women who underwent ≥4 IVF cycles compared to those with one to three cycles were at risk to develop breast cancer, although not significantly (SIR = 1.9; 95% CI 0.95–3.81). Of IVF-treated women 85% had ER(+) tumors and 29% had positive family history. Conclusions A possible association between IVF therapy and breast cancer development was demonstrated, especially in women ≥40 years of age. These preliminary findings need to be replicated in other cohort studies.     

REG Iα is a Reliable Marker of Chemoradiosensitivity in Squamous Cell Esophageal Cancer Patients

Background A reliable marker of chemoradiosensitivity that would enable appropriate and individualized treatment of thoracic squamous cell esophageal cancer has long been sought. We investigated whether regenerating gene (REG) Iα is such a marker. Methods We assessed expression of REG Iα in untreated endoscopic biopsy specimens and examined the correlation between REG Iα expression and the clinical responses to definitive chemoradiotherapy and prognosis. We also examined the relationship between REG Iα expression in the resected tumor and the prognosis of patients who received esophagectomy for thoracic squamous cell esophageal cancer. Results Among the 42 patients treated with definitive chemoradiotherapy, 8 of the 23 REG I-positive patients (35%) showed complete responses to chemoradiotherapy, while only one of the 19 REG I-negative patients did so. The survival rate among the REG I-positive patients was significantly better than among the REG I-negative patients. For the 76 patients treated surgically, there was no significant difference in the survival rates among the REG I-positive and REG I-negative patients. Conclusions REG Iα expression in squamous cell esophageal carcinoma may be a reliable marker of chemoradiosensitivity. We anticipate that it will enable us to provide more appropriate and individualized treatment to patients of advanced esophageal squamous cell carcinoma.     

The Basis of Racial Differences in the Incidence of Thyroid Cancer

Background The incidence of thyroid cancer in black Americans is half that in white Americans. It is unknown whether this gap represents a population difference in disease or is attributable to inferior cancer screening in the black population. Methods A population-based cohort study of 53,990 patients (1973–2003) was performed using the National Cancer Institute’s Surveillance Epidemiology End Results database. Socioeconomic variables were explored using the Healthcare Cost and Utilization Project database and macroeconomic data. Results Since 1973, thyroid cancer incidence among whites has increased 150.2% (4.0 to 9.9 of 100,000), while incidence among blacks has increased 73.2% (3.0 to 5.1 of 100,000). Across 17 regions, the incidence correlated with the percentage of the population with health insurance (r = 0.56, P = .02). Regression analysis suggested that half of the black-white incidence gap might be attributable to differences in health insurance status. Patients with thyroid cancer were more likely to be insured or reside in wealthier ZIP codes. Black patients were more likely to present at advanced age (RR 1.08, P < .0001) and with tumors >4 cm in size (RR 1.13, P <.0001). Black patients were slightly less likely to present with advanced disease (RR 0.96, P = .0008). Cancer-specific mortality was identical in the two populations. Discussion Sociodemographic data and differences at presentation support a small detection disparity in thyroid cancer, which may contribute to part of the incidence gap. However, this effect is not sufficiently strong to fully explain the incidence gap. A population difference in the incidence of disease may be coexistent.     

Perimembrane Aurora-A Expression is a Significant Prognostic Factor in Correlation with Proliferative Activity in Non-Small-Cell Lung Cancer (NSCLC)

Purpose Aurora-A, also known as STK15/BTAK, is a member of the protein serine/threonine kinase family, and experimental studies have revealed that Aurora-A plays critical roles in cell mitosis and in carcinogenesis. However, no clinical studies on Aurora-A expression in non-small-cell lung cancer (NSCLC) have been reported. Thus, the present study was conducted to assess the clinical significance of Aurora-A status. Experimental Design A total of 189 consecutive patients with resected pathologic (p-)stage I-IIIA, NSCLC were retrospectively reviewed, and immunohistochemical staining was used to detect Aurora-A expression. Results Aurora-A expression was negative in 31 patients (16.4%); among Aurora-A positive patients, 124 patients showed pure diffuse cytoplasmic Aurora-A expression and the other 34 patients showed perimembrane Aurora-A expression. Perimembrane Aurora-A tumors showed the highest proliferative index (PI) (mean PIs for negative, diffuse cytoplasmic, and perimembrane tumors: 49.2, 41.7, and 63.5, respectively; P < .001). Five-year survival rates of Aurora-A negative, diffuse cytoplasmic, and perimembrane patients were 67.8%, 66.7%, and 47.6%, respectively, showing the poorest postoperative survival in perimembrane patients (P = .033). Subset analyses revealed that perimembrane Aurora-A expression was a significant factor to predict a poor prognosis in squamous cell carcinoma patients, not in adenocarcinoma patients. A multivariate analysis confirmed that perimembrane Aurora-A expression was an independent and significant factor to predict a poor prognosis. Conclusions Perimembrane Aurora-A status was a significant factor to predict a poor prognosis in correlation with enhanced proliferative activity in NSCLC.