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ABSTRACT: Seit Erstbeschreibung der chronisch rekurrierenden multifokalen Osteomyelitis (CRMO) 1972 durch Giedion et al. wurde international
über mehr als 200 Fälle berichtet. Es handelt sich hierbei um eine erworbene, nichteitrige entzündliche Skeletterkrankung
bislang unbekannter Genese. Sie betrifft bevorzugt das Kindes- und Jugendalter mit kleidospondylometaphysärem Befallsmuster.
Lediglich etwa 10% der Fälle beginnen im frühen oder späteren Erwachsenenalter mit einer Häufigkeitsverschiebung des Befalls
von der Klavikula zum Sternum und an den langen Röhrenknochen von der Metaphyse zur Diaphyse.
Wir berichten den Fall einer 25-jährigen Patientin, bei der im Rahmen der Abklärung eines “akuten HWS-Syndroms” auswärts im
konventionellen Röntgen eine Sklerosierung des 6. Halswirbelkörpers (HWK) – ohne adäquates Trauma in der Vorgeschichte – nachgewiesen
werden konnte. Die weitere diagnostische Abklärung erfolgte mittels MRT und 3-Phasen-Skelettszintigraphie. Letztere zeigte
einen intensiv gesteigerten Stoffwechsel im Bereich der unteren Halswirbelsäule (HWS) und zusätzlich am Übergang vom Manubrium
zum Corpus sterni. Die histologische Untersuchung eines Biopsats bestätigte eine chronische Osteomyelitis. Des Weiteren bestand
neben einer herdförmigen Knochensklerose eine lymphoplasmazelluläre Infiltration unter Beteiligung einzelner eosinophiler
und neutrophiler Granulozyten. Kulturell erfolgte ausschließlich der Nachweis von sehr wenig Anaerobiern der Propionibacterium
species. In Anbetracht der Befunde aus Klinik, Bildgebung, Histologie und Mikrobiologie wurde die Diagnose “chronisch rekurrierende
multifokale Osteomyelitis mit sternospondylärem Befall” gestellt. Der Fall wird in dieser Arbeit anhand einer Literaturübersicht
diskutiert.
Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, inflammatory, skeletal disease of unknown origin, which mainly
affects children and adolescents in terms of cleido-spondylo-metaphysal skeletal inflammation. Only 10% of the patients are
older than 20 years. To date, only about 200 cases have been reported in the literature. In the course of the disease, the
initial radiological signs are osteolysis followed by sclerosis and hyperostosis in the end stage. The histological investigations
reveal chronic inflammatory infiltrates with lymphocytes and hyperostosis. Although the prognosis of CRMO, to our current
understanding, is self limiting, serious complications have been reported such as pathological fractures and compression fractures
of the spine. A recently recommended therapy scheme is based on the administration of azithromycin combined with calcitonin.
We present the case of a 25 year old female patient who has suffered from CRMO for 1.5 years with the cervical spine and the
manubrium sterni being affected. The current state of diagnosis, therapy, and prognostic outlook of this rare disease are
discussed.
Der Orthopäde 05/2012; 32(6):535-540. · 0.51 Impact Factor
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ABSTRACT: Fragestellung. Bei Patienten mit symptomatischer Tendinosis calcarea der Schulter beeinflusst die röntgenmorphologische Gestalt der Verkalkungen,
im deutschen Sprachraum regelmäßig klassifiziert nach Gärtner,Therapie und Prognose. Ziel war es die Intraoberserverreproduzierbarkeit
und Interobserverreliabilität dieser Klassifikation zu überprüfen.
Methodik. Die Röntgenbilder (a.p.-Projektion) von 100 Patienten mit symptomatischen Verkalkungender Supraspinatussehne wurden von 6
unabhängigen Untersuchern unterschiedlichen Ausbildungsstandes und verschiedener Fachdisziplinen 2-mal innerhalb von 4 Monaten
entsprechend der Kriterien von Gärtner klassifiziert.Die Intraoberserverreproduzierbarkeit und Interobserverreliabilität wurden
gemäß dem κ-Index nach Cohen bestimmt.
Ergebnisse. Die κ-Werte der Intraobserverreproduzierbarkeit lagen im Mittel bei 0,4208 (SD 0,1299),der Interobserverreliabilität bei
0,490 für die 1.Untersuchung und 0,474 für die 2.Untersuchung.
Schlussfolgerungen. Die Intraobserverreproduzierbarkeit ergab ein ungenügendes bis befriedigendes, die Interobserverreliabilität zu beiden Untersuchungszeitpunkten
eine ausreichende Übereinstimmung. Die klinische Verwendung der Klassifikation nach Gärtner zur Therapieplanung und Prognosestellung
bei symptomatischer Tendinosis calcarea ist nur eingeschränkt zu empfehlen.
Aim of the study. The roentgenologic morphology of symptomatic calcified deposits of the rotator cuff can be classified according Gärtner.This
classification influences therapeutic procedures and prognosis of clinical outcome in these patients. In the present study
intraoberserver-reproducibility and interobserver-reliability of Gärtner's classification were tested.
Methods. Plane radiographs of 100 patients with calcifications of the supraspinatus tendon were classified according the criteria
of Gärtner by 6 independent observers twice within 4 months.Intraoberserver-reproducibility and interobserver-reliability
were calculated by means of Cohen's κ-index.
Results. κ-values of intraoberserverreproducibility had a mean of 0.4208 (SD 0.1299), κ-values of interobserver-reliability were 0.490
for the first and 0.474 for the second classification.
Conclusions. Determination of intraoberserver-reproducibility gave insufficient to satisfactory results, interobserver-reliability was
sufficient.The clinical use of Gärtner's classification to plan therapeutic procedures or to determine clinical prognosis
in patients with calcifying tendinitis can be recommended only with limitations.
Der Unfallchirurg 04/2012; 106(3):185-189. · 0.61 Impact Factor
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ABSTRACT: Das Foramen sublabrale (FS) gilt als asymptomatische Variante des Labrum-Kapsel-Komplexes am anterosuperioren Glenoidrand
und ist ein Nebenbefund bei der Schulterarthroskopie, der mit traumatischen Ablösungen des Labrum-Kapsel-Komplexes verwechselt
werden kann.
Um Aufschluss über die Genese des FS zu bekommen,wurden in einer anatomischen Studie an makroskopisch gesunden Schulterpräparaten
(n=89) die Altersabhängigkeit des FS und seine Inzidenz in Abhängigkeit der Glenoidform als mögliche Einflussfaktoren überprüft.Zusätzlich
erfolgte eine histologische Aufarbeitung dreier Präparate mit FS.Das Durchschnittsalter der Präparate mit FS [n=20; 69 (37–84)
Jahre] lag – verglichen mit den Präparaten ohne FS [n=69,59 (18–94) Jahre] – signifikant höher (p<0,04). Ein Zusammenhang
zwischen Glenoidform und Inzidenz des FS konnte nicht nachgewiesen werden, auch wenn ein gehäuftes Auftreten einer ventralen
Inzisur der Cavitas glenoidalis gegenüber anderer Formvarianten auffiel.
Die Ergebnisse unterstützen die Vermutung, dass es sich beim Foramen sublabrale um eine altersabhängige, demnach erworbene
Variante handelt.Daher sollten insbesondere beim jüngeren Patienten mit einer Labrumablösung am anterosuperioren Glenoidrand
lokale Verletzungszeichen und die Integrität des Bizepsankers zur Diagnosesicherung überprüft werden.
The sublabral foramen is considered to be a clinically asymptomatic, isolated variant of the anterior-superior capsulo-labral-complex.
It may be observed during shoulder arthroscopy and may implicate problems in differential diagnosis of traumatic lesions.
In an anatomic study on 89 macroscopically healthy shoulder specimens the age distribution and the incidence in relation to
the varying shape of the glenoid as feasible factors of influence for a sublabral foramen (SF) were analyzed in order to illucidate
the unknown pathogenesis of SF. In addition histologic sections of three SF samples were obtained. Mean age of the specimens
with a sublabral foramen [n=20; 69 (37–84) years] was significantly higher (p=0.04) compared to samples without a sublabral
foramen [n=69; 59 (18–94) years]. An increased incidence of a sublabral foramen in relation to a distinct shape of the glenoid
could not be established allthough a prevalence of a glenoid with anterior notch was observed.
The results indicate an age-related development of the sublabral foramen,thus in younger patients with an anterior-superior
capsulolabral displacement local signs of trauma and involvement of the biceps anchor should be controlled before definitive
diagnosis.
Der Unfallchirurg 04/2012; 105(12):1088-1091. · 0.61 Impact Factor
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ABSTRACT: There is a persisting need for effective therapies of femoral head necrosis, a common bone disease. Promising clinical results have been stated for the treatment with extracorporeal shock waves (ESW). However, the effective remaining pressure in the target region inside the femoral head has never been determined. Aim of this study was to investigate whether ESW are able to propagate through bone without an excessive loss of pressure. The remaining ESW pressure generated by an electromagnetic device after passing a certain intraosseous distance within the femoral head was measured. Standardized holes were drilled in porcine femora and the absorption in relation to reference measurements in degassed water was determined. The results showed continuous attenuation of shock waves in bone. After a clinical relevant intraosseous distance of 10 mm an ESW pressure of approximately 50% remained. In conclusion, ESW have the potential to reach necrotic regions with therapeutic pressure levels and to effectively treat femoral head necrosis.
Journal of biomechanics 05/2010; 43(11):2065-9. · 2.66 Impact Factor
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ABSTRACT: Application of extracorporeal shockwaves (ESW) to the musculoskeletal system may induce long-term analgesia in the treatment of chronic tendinopathies of the shoulder, heel and elbow. However, the molecular and cellular mechanisms behind this phenomenon are largely unknown. Here we tested the hypothesis that long-term analgesia caused by ESW is due to selective loss of nerve fibers in peripheral nerves. To test this hypothesis in vivo, high-energy ESW were applied to the ventral side of the right distal femur of rabbits. After 6 weeks, the femoral and sciatic nerves were investigated at the light and electron microscopic level. Application of ESW resulted in a selective, substantial loss of unmyelinated nerve fibers within the femoral nerve of the treated hind limb, whereas the sciatic nerve of the treated hind limb remained unaffected. These data might indicate that alleviation of chronic pain by selective partial denervation may play an important role in the effects of clinical ESW application to the musculoskeletal system.
Neuroscience 05/2008; 155(1):138-44. · 3.38 Impact Factor
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ABSTRACT: Whereas various molecular working mechanisms of shock waves have been demonstrated, no study has assessed in detail the influence of varying energy flux densities (EFD) on new bone formation in vivo.
Thirty Chinchilla bastard rabbits were randomly assigned to 5 groups (EFD 0.0, 0.35, 0.5, 0.9 and 1.2 mJ/mm2) and treated with extracorporeal shock waves at the distal femoral region (1,500 pulses; 1 Hz frequency). To investigate new bone formation, animals were injected with oxytetracycline at days 5-9 after shock wave application and sacrificed on day 10. Histological sections of all animals were examined using broad-band epifluorescent illumination, contact microradiography and Giemsa-Eosin staining.
Application of shock waves induced new bone formation beginning with 0.5 mJ/mm2 EFD and increasing with 0.9 mJ/mm2 and 1.2 mJ/mm2. The latter EFD resulted in new bone formation also on the dorsal cortical bone; cortical fractures and periosteal detachment also occurred.
Here, for the first time, a threshold level is presented for new bone formation after applying shock waves to intact bone in vivo. The findings of this study are of considerable significance for preventing unwanted side effects in new approaches in the clinical application of shock waves.
European Surgical Research 02/2008; 41(1):44-53. · 0.93 Impact Factor
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ABSTRACT: The biologic action of extracorporeal shock wave application on the musculoskeletal system is understood poorly. To prove the hypothesis that alterations of tissue concentrations of substance P and prostaglandin E(2) are involved in the biologic action of shock waves, extracorporeal shock waves with energy flux density of 0.9 mJ/mm(2 )(1500 pulses at 1/s) were applied in vivo to the distal femur of rabbits. The concentrations of substance P and prostaglandin E(2) eluated from the periosteum of the femur were measured. Compared with the untreated contralateral hindlimbs, substance P release from the periosteum from the femur was increased 6 and 24 h after extracorporeal shock wave application, but was decreased 6 weeks after extracorporeal shock wave application. By contrast, extracorporeal shock wave application did not result in altered prostaglandin E(2) release from the periosteum from the femur. Remarkably, there was a close relationship between the time course of substance P release found here, and the well-known clinical time course of initial pain occurrence and subsequent pain relief after extracorporeal shock wave application to tendon diseases. Accordingly, substance P might be involved in the biologic action of extracorporeal shock wave application on tissue of the musculoskeletal system. This is the first study providing insights into the molecular mechanisms of extracorporeal shock wave application to the musculoskeletal system.
Der Schmerz 01/2005; 18(6):492-7. · 0.88 Impact Factor
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ABSTRACT: The purpose of this study was to test the hypothesis that shock waves can induce new bone formation even without cortical fractures and periosteal detachment as suggested in the literature.
Extracorporeal shock waves with energy flux densities between 0 mJ/mm(2) (sham treatment) and 1.2 mJ/mm(2) were applied in vivo to the distal femoral region of rabbits (1500 pulses at 1 Hz frequency each). Oxytetracycline was injected on days 5-9 and the animals were sacrificed on day 10. Sections of both femora of all animals were investigated with broadband fluorescence microscopy and contact microradiography for new periosteal and endosteal bone, periosteal detachment, cortical fractures, and trabecular bone with callus.
Shock waves with energy flux densities of 0.9 mJ/mm(2) and 1.2 mJ/mm(2) resulted in new periosteal bone formation in the presence of cortical fractures and periosteal detachment. After application of shock waves with energy flux density of 0.5 mJ/mm(2), clearly detectable signs of new periosteal bone formation were observed without cortical fractures or periosteal detachment.
The results of this study challenge the current view in the literature that the creation of cortical fractures and periosteal detachment are prerequisites for new bone formation mediated by extracorporeal shock waves.
Der Orthopäde 01/2005; 33(12):1401-10. · 0.51 Impact Factor
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ABSTRACT: HintergrundZiel dieser Arbeit war, zu berprfen, ob die Induktion der Knochenneubildung durch extrakorporale Stowellen auch ohne das in der Literatur propagierte Vorliegen kortikaler Frakturen und Periostablsungen mglich ist.MethodeExtrakorporale Stowellen mit Energieflussdichten zwischen 0mJ/mm2 (Scheinbehandlung) und 1,2mJ/mm2 wurden in vivo auf distale Kaninchenfemora appliziert (1500 Impulse, Frequenz 1Hz). An den Tagen 5–9 wurde Oxytetrazyklin injiziert, nach 10Tagen wurden die Tiere gettet. Histologische Schnitte beider Femora aller Tiere wurden mittels Breitbandfluoreszenzmikroskopie sowie Kontaktradiographie auf periostale und endostale Knochenneubildung, periostale Ablsung, kortikale Frakturen und Kallusbildung untersucht.ErgebnisseStowellen der Energieflussdichten 0,9mJ/mm2 und 1,2mJ/mm2 fhrten zu periostaler Knochenneubildung bei gleichzeitigem Vorliegen von kortikalen Frakturen und periostaler Ablsung. Nach Stowellenbehandlung mit einer Energieflussdichte von 0,5mJ/mm2 konnten eindeutige Zeichen der periostalen Knochenneubildung ohne kortikale Frakturen oder periostale Ablsung beobachtet werden.SchlussfolgerungDie Ergebnisse dieser Studie stehen im Gegensatz zur bisherigen Meinung in der Literatur, dass Knochenneubildung durch extrakorporale Stowellen nur durch das Erzeugen von kortikalen Frakturen und einer periostalen Ablsung mglich ist.BackgroundThe purpose of this study was to test the hypothesis that shock waves can induce new bone formation even without cortical fractures and periosteal detachment as suggested in the literature.MethodsExtracorporeal shock waves with energy flux densities between 0mJ/mm2 (sham treatment) and 1.2mJ/mm2 were applied in vivo to the distal femoral region of rabbits (1500 pulses at 1Hz frequency each). Oxytetracycline was injected on days 5–9 and the animals were sacrificed on day 10. Sections of both femora of all animals were investigated with broadband fluorescence microscopy and contact microradiography for new periosteal and endosteal bone, periosteal detachment, cortical fractures, and trabecular bone with callus.ResultsShock waves with energy flux densities of 0.9mJ/mm2 and 1.2mJ/mm2 resulted in new periosteal bone formation in the presence of cortical fractures and periosteal detachment. After application of shock waves with energy flux density of 0.5mJ/mm2, clearly detectable signs of new periosteal bone formation were observed without cortical fractures or periosteal detachment.ConclusionsThe results of this study challenge the current view in the literature that the creation of cortical fractures and periosteal detachment are prerequisites for new bone formation mediated by extracorporeal shock waves.
Der Orthopäde 11/2004; 33(12):1401-1410. · 0.51 Impact Factor
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ABSTRACT: The fluorescent microsphere method is one of the current techniques to determine regional blood flow in various organs. The purpose of this study was to examine the suitability of fluorescent microspheres for serial measurement of regional bone blood flow. Six anesthetized female New Zealand rabbits received five left ventricular injections of fluorescent microspheres in 20-minute intervals. To test the precision of the measurement two types of fluorescent microspheres were injected simultaneously at the first and last injections. Blood flow was calculated in the kidneys, lungs, brain, femurs, and tibias after measuring the fluorescence intensity in each reference blood and tissue sample. Comparison of blood-flow values obtained by simultaneously injected microspheres showed an excellent correlation and a minimal percentage difference at the first and last injections, indicating valid measurements of regional bone blood flow. No significant differences were observed when comparing blood flow in the corresponding regions of bones on the right side and left side. Mean blood flow in the femur and tibia significantly increased at the fourth injection whereas flow distribution within the femur and tibia essentially remained unchanged throughout the experiment. Comparison of blood flow values obtained by simultaneously injected microspheres showed moderate agreement for the kidneys and lungs at the last injections. Because this finding might be attributable to disturbances of microcirculation caused by accumulation of spheres in high-flow organs, the increase in regional bone blood flow observed in our experiments has to be interpreted carefully. This study showed that bone blood flow can be determined reliably in anesthetized rabbits by as many as three serial injections of fluorescent microspheres.
Clinical Orthopaedics and Related Research 11/2004; · 2.53 Impact Factor
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ABSTRACT: Die biologische Wirkung extrakorporaler Stowellen auf das muskuloskelettale System ist noch ungeklrt. Um die Hypothese zu berprfen, dass Vernderungen in den Gewebekonzentrationen von SubstanzP und ProstaglandinE2 bei der biologischen Wirkung von Stowellen eine Rolle spielen, wurden distale Kaninchenfemura in vivo mit Stowellen von 0,9mJ/mm2 (1500Impulse, 1Hz) behandelt. Die Konzentrationen von SubstanzP und ProstaglandinE2 wurden im Eluat des Femurperiosts gemessen. Im Vergleich zu den unbehandelten kontralateralen Hinterlufen zeigte sich 6 und 24h nach Stowellenbehandlung ein deutlicher Anstieg der Substanz-P-Freisetzung, 6Wochen danach war die Konzentration im Eluat erniedrigt. Eine Stowellenbehandlung fhrte zu keiner nderung in der Prostaglandin-E2-Freisetzung. Es besteht eine enge Beziehung zwischen dem hier gefundenen Zeitverlauf der Substanz-P-Freisetzung und dem klinisch bekannten Behandlungsschmerz mit konsekutiver Schmerzreduktion bei Stowellenbehandlung von Sehnenansatzerkrankungen. SubstanzP scheint eine wesentliche Rolle bei den molekularen Wirkmechanismen extrakorporaler Stowellen am muskuloskelettalen System zu spielen.The biologic action of extracorporeal shock wave application on the musculoskeletal system is understood poorly. To prove the hypothesis that alterations of tissue concentrations of substanceP and prostaglandinE2 are involved in the biologic action of shock waves, extracorporeal shock waves with energy flux density of 0.9mJ/mm2 (1500pulses at 1/s) were applied in vivo to the distal femur of rabbits. The concentrations of substanceP and prostaglandinE2 eluated from the periosteum of the femur were measured. Compared with the untreated contralateral hindlimbs, substanceP release from the periosteum from the femur was increased 6 and 24h after extracorporeal shock wave application, but was decreased 6weeks after extracorporeal shock wave application. By contrast, extracorporeal shock wave application did not result in altered prostaglandinE2 release from the periosteum from the femur. Remarkably, there was a close relationship between the time course of substanceP release found here, and the well-known clinical time course of initial pain occurence and subsequent pain relief after extracorporeal shock wave application to tendon diseases. Accordingly, substanceP might be involved in the biologic action of extracorporeal shock wave application on tissue of the musculoskeletal system. This is the first study providing insights into the molecular mechanisms of extracorporeal shock wave application to the musculoskeletal system.
Der Schmerz 10/2004; 18(6):492-497. · 0.88 Impact Factor
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ABSTRACT: To improve the understanding of epicondylitis by describing the normal structure and composition of the entheses associated with the medial and lateral epicondyles and their histopathology in elderly cadavers.
Medial and lateral epicondyles were obtained from 12 cadavers. Six middle aged cadavers (mean 47 years) were used to assess the molecular composition of "normal" entheses from people within an age range vulnerable to epicondylitis. Cryosections of epicondylar entheses were immunolabelled with monoclonal antibodies against molecules associated with fibrocartilage and related tissues. A further six elderly cadavers (mean 84 years) were used for histology to assess features of entheses related to increasing age.
Tendon entheses on both epicondyles fused with those of the collateral ligaments and formed a more extensive structure than hitherto appreciated. Fibrocartilage (which labelled for type II collagen and aggrecan) was a constant feature of all entheses. Entheses from elderly subjects showed extensive microscopic damage, hitherto regarded as a hallmark of epicondylitis.
Fibrocartilage is a normal feature and not always a sign of enthesopathy. Furthermore, pathological changes documented in patients with epicondylitis may also be seen in elderly people. The fusion of the common extensor and flexor tendon entheses with those of the collateral ligaments suggests that the latter may be implicated as well. This may explain why pain and tenderness in epicondylitis may extend locally beyond the tendon enthesis and why some patients are refractory to local treatments.
Annals of the Rheumatic Diseases 10/2004; 63(9):1015-21. · 8.73 Impact Factor
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ABSTRACT: Compared to pressfit cups, little information exists about the results of screwed cups in hip arthroplasty. 51 cementless or hybrid (cemented stem) primary total hip replacements with a cementless corundium blasted titaniumn alloy threaded Aesculap Munich II type cup were examined with a mean follow up of 7.9 years. 23 of the patients were male and 28 patients were female. From these cups 22 were implanted on the right side and 29 on the left. The results were compared to 53 patients (28 male, 25 female, 29 right side, 24 left side) with the threaded Aesculap Munich I type cup, that has a smooth surface and a direct contact of bone with the polyethylene inlay. The mean follow up ws 10.2 years. The early and medium to long-term clinical and radiographic results show an encouraging improvement of the Merle d'Aubigné Score of the type II cup compared to the type I cup. Two of the Aesculap type Munich II cups had to be revised; four showed radiologic signs of loosening. In conclusion, the threaded Aesculap cup type Munich II seems to be a decisive advance in the development of threaded acetabular hip cups. The intermediate results exceed those from smooth-surface screwed rings and compare favourably with those from cemented cups and with those from cementless press-fit metal-backed cups.
Acta chirurgica Belgica 09/2004; 104(4):413-7. · 0.43 Impact Factor
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ABSTRACT: Malignant transformation of solitary enchondromas of the hand to secondary chondrosarcomas is extremely rare. We report a case of a recurrent chondromatous tumor of the hand that initially presented with the typical histology of a cellular enchondroma of the small tubular bones but with clinical and radiological signs of malignancy. After development of a single pulmonary metastasis of a chondromyxoid tumor a malignant transformation of the primary enchondroma of the hand must be assumed.
Acta chirurgica Belgica 07/2004; 104(3):341-4. · 0.43 Impact Factor
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ABSTRACT: There is growing evidence that cytokines such as tumor necrosis factor (TNF) alpha, interleukin (IL) 1beta, IL-6, bone morphogenetic proteins (BMP), and nitric oxide (NO) play an important role in the pathogenesis of bone tunnel enlargement following anterior cruciate ligament (ACL) reconstruction. Furthermore, the release of these mediators has been considered a possible reason for the higher incidence of bone tunnel enlargement following hamstring tendon (HST) than following patellar tendon (PT) ACL reconstruction observed in several studies. In this investigation synovial fluid samples from 13 patients were collected immediately before (24+/-7 days after ACL rupture) and 7 days after ACL surgery and values of TNF-alpha, IL-1beta, IL-6, NO, and BMP-2 were analyzed. Furthermore, the incidence of bone tunnel enlargement was assessed using radiographs 38+/-7 weeks after surgery. Six patients underwent autologous HST ACL reconstruction, and in seven patients an PT autograft was used. In the overall patient population there were significantly higher synovial fluid concentrations of IL-6 and BMP-2 postoperatively than preoperatively; TNF-alpha showed a trend towards lower postoperative levels while IL-1beta and NO remained unchanged. The concentrations of NO, TNF-alpha, and IL-6 found in the present study were clearly higher than normal values given in the literature. Assessment of bone tunnel enlargement revealed an average increase in tibial tunnel width of 28.4+/-3.1% with comparable values for HST and PT ACL reconstructions. There was no significant correlation between bone tunnel enlargement and postoperative synovial fluid concentrations of TNF-alpha, IL-1beta, IL-6, NO, and BMP-2. However, all patients with bone tunnel enlargement had higher postoperative concentrations of TNF-alpha, IL-6, and NO in the synovial fluid. There were no significant differences in concentrations between HST and PT groups. In conclusion, we observed an association between tibial bone tunnel enlargement and elevated synovial fluid concentrations of IL-6, TNF-alpha, and NO 7 days after ACL surgery indicating the potential involvement of these biological mediators in the pathogenesis of bone tunnel enlargement. However, there was no difference between HST and PT ACL reconstructions regarding synovial fluid contents of IL-6, TNF-alpha, IL-1beta, NO, and BMP-2, suggesting a comparable biological response between these autografts following their use in ACL reconstruction.
Knee Surgery Sports Traumatology Arthroscopy 04/2004; 12(2):98-103. · 2.21 Impact Factor
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ABSTRACT: Lymphangiosarcoma (LAS) may occur as a rare complication of primary lymphedema. A case of LAS in hereditary lymphedema of the lower extremity in a 36-year old female is reported. Despite of chemotherapy, local hyperthermia and later amputation of the extremity the patient died of progressive disease due to pulmonary metastasis. In respect to this case, the different therapeutic concepts, as reported in the literature, and their results are presented and discussed.
VASA.: Zeitschrift für Gefässkrankheiten. Journal for vascular diseases 03/2004; 33(1):42-5. · 1.31 Impact Factor
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ABSTRACT: There is growing evidence that cytokines such as tumor necrosis factor (TNF) , interleukin (IL) 1, IL-6, bone morphogenetic proteins (BMP), and nitric oxide (NO) play an important role in the pathogenesis of bone tunnel enlargement following anterior cruciate ligament (ACL) reconstruction. Furthermore, the release of these mediators has been considered a possible reason for the higher incidence of bone tunnel enlargement following hamstring tendon (HST) than following patellar tendon (PT) ACL reconstruction observed in several studies. In this investigation synovial fluid samples from 13 patients were collected immediately before (247days after ACL rupture) and 7days after ACL surgery and values of TNF-, IL-1, IL-6, NO, and BMP-2 were analyzed. Furthermore, the incidence of bone tunnel enlargement was assessed using radiographs 387weeks after surgery. Six patients underwent autologous HST ACL reconstruction, and in seven patients an PT autograft was used. In the overall patient population there were significantly higher synovial fluid concentrations of IL-6 and BMP-2 postoperatively than preoperatively; TNF- showed a trend towards lower postoperative levels while IL-1 and NO remained unchanged. The concentrations of NO, TNF-, and IL-6 found in the present study were clearly higher than normal values given in the literature. Assessment of bone tunnel enlargement revealed an average increase in tibial tunnel width of 28.43.1% with comparable values for HST and PT ACL reconstructions. There was no significant correlation between bone tunnel enlargement and postoperative synovial fluid concentrations of TNF-, IL-1, IL-6, NO, and BMP-2. However, all patients with bone tunnel enlargement had higher postoperative concentrations of TNF-, IL-6, and NO in the synovial fluid. There were no significant differences in concentrations between HST and PT groups. In conclusion, we observed an association between tibial bone tunnel enlargement and elevated synovial fluid concentrations of IL-6, TNF-, and NO 7days after ACL surgery indicating the potential involvement of these biological mediators in the pathogenesis of bone tunnel enlargement. However, there was no difference between HST and PT ACL reconstructions regarding synovial fluid contents of IL-6, TNF-, IL-1, NO, and BMP-2, suggesting a comparable biological response between these autografts following their use in ACL reconstruction.
Knee Surgery Sports Traumatology Arthroscopy 02/2004; 12(2):98-103. · 2.21 Impact Factor
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ABSTRACT: The distribution of the thickness of cartilage as well as of the subchondral mineralization reflects the various stresses on the joint compartments. Both long bones of the lower arm participate in load bearing. The humeroradial and humeroulnar parts of the joint are incongruent. The capitulum humeri is slightly smaller than the corresponding fovea, whereas the radius of the trochlea is bigger than that of the incisura trochlearis. Therefore, the medial compartment can be seen as a dynamic pressure-transmitting system. The collateral ligaments limit the degree of flexion and extension together with the olecranon and coronoid process. In the extreme flexed position the insertion regions of the ligaments at the humeral crests are twisted. This may explain why the corresponding entheses consist of fibrocartilage. Some molecular components of these regions can become targets of autoimmune reactions. The rotational movements are restricted by soft tissues and muscles.
Der Orthopäde 09/2003; 32(8):684-90. · 0.51 Impact Factor
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ABSTRACT: Die Verteilung von Knorpeldicke und Mineralisierung
spiegelt die vielseitige Beanspruchung der Gelenkkrper des
Ellenbogengelenks wider. ber beide Unterarmknochen werden
Druckkrfte bertragen.Sowohl Humeroradial- als auch
Humeroulnargelenk sind jeweils inkongruent. Im lateralen
Gelenkabschnitt ist der konvexe Gelenkkrper geringfgig
kleiner, im medialen Anteil ist der konvexe Gelenkkrper grer.
Dies erlaubt eine dynamische Anpassung der Kontaktflchen an die
Anpresskraft.Die Kollateralbnder begrenzen im Zusammenwirken mit
Olecranon und Processus coronoideus die Bewegung in der
Sagittalebene. In der Endstellung der Beugung werden sie dabei
im Bereich ihrer proximalen Anheftung in sich verdreht.
Dementsprechend sind ihre Anheftungszonen aus Faserknorpel
aufgebaut. Einige der molekularen Komponenten knnen zu
Angriffspunkten von Autoimmunreaktionen werden. Das Ausma der
Rotation wird durch die Weichteile gehemmt.The distribution of the thickness of cartilage as well as
of the subchondral mineralization reflects the various stresses
on the joint compartments. Both long bones of the lower arm
participate in load bearing. The humeroradial and humeroulnar
parts of the joint are incongruent. The capitulum humeri is
slightly smaller than the corresponding fovea, whereas the
radius of the trochlea is bigger than that of the incisura
trochlearis. Therefore, the medial compartment can be seen as a
dynamic pressure-transmitting system.The collateral ligaments limit the degree of flexion and
extension together with the olecranon and coronoid process. In
the extreme flexed position the insertion regions of the
ligaments at the humeral crests are twisted. This may explain
why the corresponding entheses consist of fibrocartilage. Some
molecular components of these regions can become targets of
autoimmune reactions. The rotational movements are restricted by
soft tissues and muscles.
Der Orthopäde 07/2003; 32(8):684-690. · 0.51 Impact Factor
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ABSTRACT: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, inflammatory, skeletal disease of unknown origin, which mainly affects children and adolescents in terms of cleido-spondylo-metaphysal skeletal inflammation. Only 10% of the patients are older than 20 years. To date, only about 200 cases have been reported in the literature. In the course of the disease, the initial radiological signs are osteolysis followed by sclerosis and hyperostosis in the end stage. The histological investigations reveal chronic inflammatory infiltrates with lymphocytes and hyperostosis. Although the prognosis of CRMO, to our current understanding, is self limiting, serious complications have been reported such as pathological fractures and compression fractures of the spine. A recently recommended therapy scheme is based on the administration of azithromycin combined with calcitonin. We present the case of a 25 year old female patient who has suffered from CRMO for 1.5 years with the cervical spine and the manubrium sterni being affected. The current state of diagnosis, therapy, and prognostic outlook of this rare disease are discussed.
Der Orthopäde 07/2003; 32(6):535-40. · 0.51 Impact Factor
