Revascularized fibula for tibia replacement in adamantinoma

Adamantinoma of long bones is one of the rarest of malignant bone tumors; it is commonly located in the middle or lower third of the diaphysis of the tibia. A case with multiple occurrences affecting both the tibia and fibula is presented. En bloc resection with wide operative margins was performed, and a large tibial defect of 23 cm was effectively bridged by a revascularized free fibular flap. At 13 months follow-up, there was no sign of local recurrence or metastasis, and the patient was mobile.     

Aktualisierte Kurzfassung der Leitlinien zur Pr?vention, Diagnostik und Therapie der nosokomial erworbenen Pneumonie

Hintergrund:  

Die nosokomiale Pneumonie gehört zu den häufigsten nosokomialen Infektionen und ist die häufigste auf der Intensivstation. Die nosokomiale Pneumonie ist mit einer signifikanten Mortalität und Morbidität assoziiert, und ihr Auftreten verschlechtert die Prognose des Patienten deutlich. Nach der Definition der DRGs auch im deutschen Krankenhaussystem ist die nosokomiale Pneumonie überwiegend Sache des Krankenhauses und kann somit nicht nur das Ergebnis der Patientenbehandlung, sondern auch das finanzielle Ergebnis des Krankenhauses beeinträchtigen.     

Molecular determinants of cetuximab efficacy.

PURPOSE: To investigate whether mRNA expression levels of cyclin D1 (CCND1), cyclooxygenase 2 (Cox-2), epidermal growth factor receptor (EGFR), interleukin 8 (IL-8), and vascular endothelial growth factor (VEGF), all members of the EGFR signaling pathway, are associated with clinical outcome in patients with EGFR-expressing metastatic colorectal cancer (CRC) treated with cetuximab. PATIENTS AND METHODS: Thirty-nine patients with metastatic CRC, refractory to both irinotecan and oxaliplatin, were enrolled on IMCL-0144 and treated with single-agent cetuximab. The intratumoral mRNA levels of CCND1, Cox-2, EGFR, IL-8, and VEGF were assessed from paraffin-embedded tissue samples using laser-capture microdissection and quantitative real-time polymerase chain reaction. RESULTS: There were 21 women and 18 men with a median age of 64 years (range, 35 to 83 years). Higher gene expression levels of VEGF were associated with resistance to cetuximab (P = .038; Kruskal-Wallis test). The combination of low gene expression levels of Cox-2, EGFR, and IL-8 was significantly associated with overall survival (13.5 v 2.3 months; P = .028; log-rank test). Both findings were independent of skin toxicity that was itself significantly correlated to survival. Patients with a lower mRNA amount of EGFR had a longer overall survival compared with patients that had a higher mRNA amount (7.3 v 2.2 months; P = .09; log-rank test). Patients with lower expression of Cox-2 had a significantly higher rate of grade 2 to 3 skin reactions under cetuximab treatment. CONCLUSION: This pilot study suggests that gene expression levels of Cox-2, EGFR, IL-8, and VEGF in patients with metastatic CRC may be useful markers of clinical outcome in single-agent cetuximab treatment.     

Zur Ätiologie und Prophylaxe des Ernte- bzw. Feldfiebers in Südbayern

Zusammenfassung Aufgabe der vorstehenden epidemiologischen Untersuchung war es, die Tatsachen des örtlichen und zeitlichen Auftretens des Erntefiebers bzw. Felfdiebers in das Licht derPettenkoferschen Auffassung von der örtlich-zeitlichen Bedingtheit der Seuchenentstehung zu stellen.Dabei ist zugleich ein klärendes Licht gefallen auf die Zusammenhänge, in welchen dieses Ernte- oder Feldfieber zur Hepatitis epidemica, zurWeilschen Krankheit, zum epidemischen Wasserfieber und zum Sumpfoder Schlammfieber steht. Zugleich haben wir gesehen, daß es sich bei allen diesen verwandten Krankheitszuständen umeine Endemizität der Krankheitsursachen handelt, welche in einer Reihe der Fälle eine Übertragung von Person zu Person vortäuscht. Damit wäre auch der soviel umstrittene infektiöse Charakter dieser Krankheitszustände geklärt.So haben wir gesehen, daß auf diesem vonPettenkofer gewiesenen Forschungswege doch eine gewisse Klärung der Ätiologie zu gewinnen ist, die auf dem bakteriologischen bzw. parasitologischen Forschungswege nicht erreicht ist. Auch haben sich gewisse Anhaltspunkte für eine Verhütung dieser neuen endemischen Krankheit ergeben, die, wenn sich ihre Beachtung als erfolgreich erweisen sollte, für die Durchführung des Vierjahresplanes, soweit dieselbe auf der Erntearbeit beruht, von Wichtigkeit sein würden.     

Comparative early and midterm results of open juxtarenal and infrarenal aneurysm repair

Background and aims Since the introduction of endovascular aortic aneurysm repair (EVAR) for aortic aneurysms, the number of juxtarenal aortic aneurysms (JRA) has been growing steadily due to selection bias (neck morphology for EVAR). This case-match study compares the perioperative outcome and midterm results of suprarenally clamped JRA with infrarenal aortic aneurysms (AAA). Methods From 1997 to 2004, patients who received open surgery with suprarenal clamping for JRA were included in the study and compared to matched patients with infrarenal clamping (AAA). Measurements analyzed were the in-hospital mortality and morbidity. Midterm results were obtained through clinical investigation and magnetic resonance angiography imaging. Results Thirty-five patients (mean age, 68.4 years; 30 male and 5 female) received suprarenal cross-clamping for JRA. The overall in-hospital mortality for JRA and for the controls (AAA) with elective aortic repair was 4.5% (6.1% JRA; 3% AAA, p = 0.058). The morbidity of JRA was elevated according to the rate of pulmonary complications (p = 0.021) and the need for re-operation (p = 0.019). The mean follow-up time was 2.3 years (range, 8–96 months). At follow-up, 28 patients (80%) from the JRA group and 29 patients from the AAA group (82.9%) were alive. Conclusion Open aortic surgery for JRA with the need for suprarenal cross-clamping shows a slightly elevated in-hospital mortality rate without statistical significance and equal midterm mortality results in comparison with infrarenally clamped aortic aneurysms.     

Sonography as a training tool for screening of dubious midfacial fractures]

BACKGROUND: In uncertain midfacial fractures, sonography is an alternative first-line imaging modality to conventional radiographs. Patients with sonographically confirmed fractures can then be directly admitted to three-dimensional imaging, resulting in decreased radiation exposure since the conventional radiographs are omitted. MATERIAL AND METHODS: Using a high-frequency linear and curved array scanner in a healthy proband, images of the zygomatic arch, anterior maxillary sinus wall, infraorbital rim, and lateral orbital wall were obtained. For identification and anatomical allocation corresponding navigated ultrasound images of a reference skull were generated and fused with a segmented CT data set. Navigated sonography was reproduced in a patient with orbitozygomatical fracture of the left side. Therefore, the CT data set, performed during preoperative diagnostics, was fused with the ultrasound images. RESULTS: Because of different coupling shapes, the high-frequency linear array scanner was subjectively found to be more suitable for sonography in the field of the zygomatic arch, anterior maxillary sinus wall, and infraorbital rim, and the curved array scanner was better suited for transbulbar sonography of the orbital walls. After coupling sonography with the navigation system and referencing the scanner, it was possible to verify ultrasound findings objectively by navigation of the scanner and fusion with the CT data set. Using the reference skull, ultrasound images corresponding to normal findings were obtained and with the fused CT data, providing colored segmentation of the facial bones, an anatomically correct identification was possible. Clinical application of this tool is described in a patient with left-sided orbitozygomatical fracture. CONCLUSION: By fusion of ultrasound images and corresponding CT data with the help of a navigation system, a sonographic training tool for preliminary evaluation of midfacial fractures is available.