[Monocondylar fractures of the femur. Therapeutic strategy and clinical outcome]

Twenty-nine unicondylar fractures of the distal femur were treated at the Trauma Center "Bergmannsheil", University of Bochum, Germany, between 1981 and 1994. All patients sustained their injuries from severe direct trauma. There were 16 lateral condylar fractures, 7 medial condylar fractures and 6 tangential posterior ("Hoffa-type") fractures. Twenty-eight closed injuries and 1 grade IIIB open fracture injuries to the skeleton. All fractures were treated with open reduction and internal fixation with screws within 8 h of admission. Postoperative management consisted of early continuous passive motion and minimal weight-bearing for 6-8 weeks, progressing to full weight-bearing. The mean follow-up was 68 months (18-120). The therapeutic outcome (clinical result, radiographs) was rated by the Neer score. Twenty-seven patients were available for follow-up examination. Of these, 23 were rated as excellent. 3 achieved satisfactory results, and 1 had an unsatisfactory result. All patients who did not achieve an excellent outcome had had accompanying injuries. Open reduction and internal screw fixation of unicondylar femur fractures provided overall excellent long-term results. The therapeutic outcome was significantly affected by associated injuries of the skeleton.

Expression of bcl-2--protein in small cell lung cancer

The expression of the proto-oncogene bcl-2, whose main function appears to be an inhibition of apoptosis, was investigated in 164 cases of primary small cell lung cancer by means of immunohistochemistry in a retrospective analysis. One-hundred twenty-five cases (76%) demonstrated expression of bcl-2. There was no difference in serum LDH levels and proliferative activity between the two groups. An analysis revealed a median survival time of 12 months for patients with bcl-2 positive tumors compared to 9.5 months for patients with bcl-2 negative tumors. Although statistical significance is not achieved, there is a trend towards longer survival in patients whose tumors express bcl-2. This tendency is also reflected by a higher rate of complete remission after chemotherapy: 40% in patients with bcl-2+ tumors versus 27% in patients with bcl-2- tumors. In multivariate analysis, tumor stage followed by Karnofsky index were the most valuable predictors for complete remission. LDH and tumor stage were most predictive for 1-year survival. Bcl-2 expression is frequent in SCLC and may reflect a less aggressive mechanism of transformation and a higher susceptibility to cytostatic treatment.

[Radiologic skeletal diagnosis: traumatology of the distal forearm, the wrists and the hand]

Plain X-ray films including some special radiographic views are still the basis of the radiological evaluation of injuries of the distal forearm, the wrist, and the hand. Especially in the diagnosis of fractures of the distal radius the exact positioning of the arm and hand is essential. For the description of fractures of the distal forearm the AO classification of fractures should be used, which is comprehensive and universally applicable. Conventional tomography and computed tomography (CT) of the radio-ulnar joint and the wrist are used in patients with persisting complaints or equivocal findings on plain radiographs, and difficult anatomical situations. Suspected ligamentous injuries of the wrist including tears of the triangular fibrocartilage complex (TFCC) are evaluated by wrist arthrography or magnetic resonance imaging (MRI), the latter requiring a highly skilled imaging and interpretation technique. MRI is the method of choice for the detection of osteonecrosis. Ultrasound examination are of minor importance in the work up of wrist and hand injuries.

Initial clinical experience with spiral CT and 3D arterial reconstruction in intracranial aneurysms and arteriovenous malformations

We studied 32 consecutive patients with known or suspected cerebrovascular abnormalities studied with spiral CT following a intravenous bolus injection of iodinated contrast medium with a power injector. Flow was 3 or 4 ml/s. In an attempt to define the appropriate delay time and scan duration a cranial angio-CT without table increment was performed on 10 patients. Enhancement was measured by manually placed regions of interest within the left middle cerebral artery and the inferior sagittal sinus. All patients except one had intraarterial angiography (DSA) for comparison. In 6 patients with an arteriovenous malformation (AVM) follow-up was possible after one and/or two embolisation procedures. These patients had plain and contrast-enhanced spiral CT. The diagnosis was aneurysm in 9 (8 berry aneurysms, one giant fusiform aneurysm), AVM in 13 (all supratentorial) and traumatic arteriovenous fistula in one. In 9 patients there were no detectable pathological vascular findings. After 3D reconstruction the size (between 5 and 28 mm), location and the relationship to the parent vessel of the aneurysms, the extent of the AVMs and the distribution of the embolisation material could be demonstrated clearly. The main feeding vessel(s), nidus and draining veins were reliably shown. The decreased extent of the AVMs after embolisation was clearly demonstrated. There was no difference in diagnosis when DSA and 3D-CT were compared by two independent radiologists. We consider arterial spiral CT with 3D reconstruction to have the potential of offering important diagnostic information for the treatment of intracranial AVMs and aneurysms.

Influence of different volume therapies and pentoxifylline infusion on circulating soluble adhesion molecules in critically ill patients

OBJECTIVE

To study the influence of long-term volume therapy with different solutions and continuous administration of pentoxifylline on plasma concentrations of circulating adhesion molecules.

DESIGN

Prospective, randomized study.

SETTING

A surgical intensive care unit (ICU) of a university hospital.

PATIENTS

Forty-two patients with sepsis secondary to major surgery were included.

INTERVENTIONS

The patients were randomly separated into three groups. In group 1 (n=14), volume therapy was exclusively carried out with 10% low-molecular-weight hydroxyethyl starch solution. In group 2 (n=14), patients exclusively received 20% human albumin for volume therapy. In group 3 (n=14), volume therapy was not defined and pentoxifylline was continuously given (1.4 mg/kg/hr iv).

MEASUREMENTS AND MAIN RESULTS

From arterial blood samples, plasma concentrations of soluble adhesion molecules (endothelial leukocyte adhesion molecule-1 [soluble ELAM-1], intercellular adhesion molecule-1 [soluble ICAM-1], vascular cell adhesion molecule-1 [soluble VCAM-1], and soluble granule membrane protein-140) were serially measured on the day of admission to the ICU ("baseline" value) and during the next 5 days at noon. No significant differences between the three groups were found for macrohemodynamics. Soluble ELAM-1, soluble ICAM-1 and soluble VCAM-1 plasma concentrations were markedly higher than normal values at baseline in all groups. In the hydroxyethyl starch group, soluble ELAM-1 plasma concentration decreased to the normal range, whereas it further increased in the human albumin group and was almost unchanged in the pentoxifylline group. During the study period, soluble ICAM-1 and soluble VCAM-1 plasma concentrations remained unchanged in the hydroxyethyl starch group. However, these concentrations increased in the other groups. Soluble granule membrane protein-140 increased significantly only in the human albumin group (483 +/- 103 to 683 +/- 94 ng/mL). In the hydroxyethal starch-treated patients, Acute Physiology and Chronic Health Evaluation II score decreased significantly (from 24.3 +/- 3.4 at baseline to 17.0 +/- 3.3 at the end the study period). Only PaO2/FIO2 was correlated to plasma concentrations of adhesion molecules.

CONCLUSIONS

Sepsis is associated with markedly increased plasma concentrations of adhesion molecules, indicating endothelial activation or damage. By long-term volume therapy with hydroxyethal starch solution, these concentrations remained unchanged or even decreased, whereas in patients in whom human albumin was infused or pentoxifylline was given continuously, plasma concentration of soluble adhesion molecules further increased.

Expression and potential role of E-cadherin in pancreatic carcinoma

CONCLUSION

Our results indicate that loss of E-cadherin might be associated with a more invasive phenotype in pancreatic cancer.

BACKGROUND

A reduced expression of the calcium-dependent E-cadherin cell-cell adhesion molecule on tumor cells has been described as an important factor for tumor invasion and metastasis.

METHODS

Pancreatic tissues (carcinoma, chronic pancreatitis, and normal) as well as 12 pancreatic tumor cell lines were investigated for E-cadherin expression by immunohistochemistry. To correlate the motility of pancreatic tumor cells in vitro with E-cadherin expression, we used a Boyden chamber assay.

RESULTS

In pancreatic carcinoma tissues, diffuse growing tumor cells showed a decrease or loss of E-cadherin expression, whereas in areas of compact tumor growth, only a slight decrease of E-cadherin was observed compared to normal pancreas or chronic pancreatitis. No correlation between the E-cadherin expression and the grading of the tumor cells, the tumor stage, or the disease progression was detectable. Of four tumor cell lines that migrated in the Boyden chamber, three were predominantly E-cadherin negative. In contrast, seven of eight cell lines that did not migrate in vitro revealed E-cadherin expression.

[External fixator or bone pin osteosyntheses in unstable distal intra-articular radius fractures in elderly patients]

Hyperdistraction with external fixation in the treatment of distal intraarticular fractures (Frykman types VII/VIII) in elderly patients results in a higher risk of secondary shortening and loss of the radius length with functional impairment. Using the modified K-wire technique of Kapandjii, a more sufficient restoration of articular congruency can be achieved. The overall score showed 87.5% excellent and good results in the Kapandjii group, compared to 76.5% in the external-fixation group.

[Results of an open study for evaluating the effectiveness and tolerance of adjuvant administration of the ISF nutrient program in HIV positive patients]

HIV positive patients usually show a gradual deterioration of their general condition and the laboratory key values which are accompanied by the resulting negative effects on their subjective condition. This study showed a very good stabilization of HIV positive patients by using the complex ISF nutrient program over a period of ten or 15 months. Only a very low proportion of antiviral and antibiotic supply had been given. The ratio did not change over the entire testing period of 15 months. The mortality rates observed here were a fraction of the AIDS mortality rates that are otherwise published. The data of this study also show a very good benefit/risk relationship for the patients, which can be derived from the overall favorable statements on the tolerance.

[Results of a multicenter study of chondroitin sulfate (Condrosulf) use in arthroses of the finger, knee and hip joints]

61 patients, suffering from osteoarthritis of the hip, knee and/or finger joints, were included into this open, multicenter, phase IV trial. Patients were treated with chondroitinsulfate (CS) at the recommended dose for 3 months. Concomitant NSAID-therapy, which was necessary for disease control at the beginning of the observation period could be reduced by 72% throughout the 3 months of CS-therapy. The decrease of pain was revealed to be statistically significant; serious side effects were not to be observed during the study. At the beginning of the observation period patients suffered from overall severe pain, and therefore the decrease of pain down to a level, which could not have been achieved by NSAID therapy alone to a greater extent, is of special interest. The results of this trial represent the first office based Austrian data on CS-therapy. In conclusion it could be demonstrated that a significant reduction of the daily NSAID consumption was possible by concomitant CS-therapy, without the risk of deterioration of the patients' symptoms. The 97% compliance does not give evidence for drop-out bias. Moreover, the results of this trial are comparable to other international double-blind, in part placebo-controlled studies, concerning CS-therapy, indicating beneficial results in the treatment of osteoarthritis.

Influence of recombinant human erythropoietin therapy on in vivo chemotaxis and in vitro phagocytosis of polymorphonuclear cells of hemodialysis patients

Recombinant human erythropoietin (rhu-EPO) mainly stimulates erythropoiesis, but also influences the production and function of polymorphonuclear granulocytes (PAN). We evaluated the influence of rhu-EPO therapy in patients on maintenance hemodialysis without iron overload on both phagocytic and chemotactic activity of polymorphonuclear leukocytes (PMN) obtained from blood and a skin chamber. The study comprised 28 dialysis patients (15 females, 13 males, age 22-78 years, dialysis sessions three times weekly 4-5 h, mean duration of dialysis treatment 4-99 months) and 20 healthy subjects (9 females, 11 males, age 18-56 years). The absolute number of leukocytes in the peripheral blood, the leukocyte mobilization (chemotactic activity) and the phagocytic activity of PMNs were tested in patients before (n = 28), and after (n = 18) reaching the target hematocrit of 30% and during the follow-up period. No alteration in the total leukocyte number (PMN, monocytes, lymphocytes) in the peripheral blood during rhu-EPO therapy could be seen. The phagocytic activity of PMNs slightly improved during the follow-up period whereas the decreased chemotactic activity remained unchanged.

[Space-occupying lesions of the lacrimal gland in CT and MRI exemplified by 4 cases]

In an extended case report, we discuss four cases with masses in the lacrimal fossa representing the most important entities in this region (lymphoma, pleomorphadenoma, inflammatory pseudotumor, and malignant epithelial tumor). The different indications for CT and MRI are explained. For the differential diagnosis of lacrimal gland lesions, the following imaging parameters are important: the shape of the lacrimal gland, the inner structure, the degree of contrast enhancement, and the surrounding bony structures. In the evaluation of the expansion of lacrimal gland lesions, CT in thin slices with multiplanar reconstructions is equal to MRI. However, the contrast-enhancement of lacrimal glands is better evaluated with MRI than with CT. The bony structures are better visualized on CT than on MRI.

Molecular and immunohistochemical p53 status in liposarcoma and malignant fibrous histiocytoma: identification of seven new mutations for soft tissue sarcomas

BACKGROUND

p53 mutations are the most frequently observed tumor-related genetic changes. Mutational analysis concerns mostly carcinomas and is not comprehensive for soft tissue sarcomas. Among soft tissue sarcomas, malignant fibrous histiocytoma (MFH) and liposarcoma represent the most frequent tumor types. Most of the few identified mutations for soft tissue sarcomas are localized in the core domain of p53. A correlation between p53 positive immunoreactivity, missense mutations, and a poor prognosis is generally assumed. However, the character of p53 mutations and their functional importance for the clinical process is still unknown.

METHODS

Sixty-two soft tissue sarcoma samples were investigated for the presence of p53 mutations and for p53 immunoreactivity. Exons 4-9 of the p53 gene were amplified from genomic DNA with the polymerase chain reaction. A prescreen for mutations was performed by nonradioactive single strand conformation polymorphism analysis; striking cases were sequenced directly. For an evaluation of the immunohistochemical status, five p53 antibodies were used.

RESULTS

In 10 tumor samples 7 new p53 mutations and one polymorphism were identified. Mutations were detected for five liposarcomas (four patients) and four MFHs (three patients). Of the seven mutations, three were missense point mutations, three were deletions, and one was a complex conversion. All mutations but one were localized in the core domain of p53. Of 62 tumor samples, 56% (14 of 32 liposarcomas and 21 of 30 MFHs) were positive for p53 immunostaining.

CONCLUSIONS

The mutations identified in the core domain affect codons that are structurally or functionally involved in DNA binding. A relation between p53 positive immunoreactivity and a poor prognosis, but not with an exclusively high tumor grade, is evident. p53 mutations in soft tissue sarcomas have a similar spectrum to those in carcinomas.

Lupus in the 1980s: III. Influence of clinical variables, biopsy, and treatment on the outcome in 150 patients with lupus nephritis seen at a single center

Of 500 patients with systemic lupus erythematosus observed at our center, 150 fulfilled criteria for lupus nephritis. Of these 150 patients, 91% were female, and 67% were white. The mean age of onset was 26.2 years, and the mean follow-up duration was 11.7 years. Biopsies (n = 142) performed on 107 patients showed the following World Health Organization (WHO) class distribution: class I, n = 1; class II, n = 13; class III, n = 19; class IV, n = 69; class V, n = 17; class VI, n = 8; and class not determinable, n = 15. Ninety-five patients were nephrotic. Therapeutic intervention courses given to all patients (n = 356) included parenteral (IV) cyclophosphamide (n = 58), high-dose oral steroids (n = 126), pulse steroids (n = 49), apheresis (n = 39), azathioprine (n = 43), oral cyclophosphamide (n = 5), nitrogen mustard (n = 27), and chlorambucil (n = 6). In addition to examining the course of disease for various subsets, various predictors for fatality and end-stage renal disease (ESRD) were analyzed. Descriptive data for the short-term response to five therapies are provided for the complete patient sample, proliferative disease, and nephrotic syndrome. Twenty patients died, primarily from cardiovascular complications and sepsis, with 97% and 92% 5- and 10-year survival rates, respectively. Twenty-nine were dialyzed, and 11 were transplanted. Risk of ESRD by WHO class at 5 years was as follows: class III, 0%; IV, 9%; V, 16% (P = .04 for class V v other patterns).(ABSTRACT TRUNCATED AT 250 WORDS)

[Estimating patient dose in computerized tomography]

This paper presents a model for the estimation of the effective patient dose in computed tomography. It is demonstrated how equivalent organ doses for selected examination can be estimated on the basis of the scanner-specific axis dose and published conversion factors. Problems and limitations of this method are discussed. The determination of the effective dose from the organ equivalent dosis is explained. The explanations are illustrated by an exemplary calculation, and the doses of the most important CT examinations are summarised.

Unrecognized pneumothorax as a cause of intraspinal air

STUDY DESIGN

This is a case report.

OBJECTIVE

A case of intraspinal air in a polytraumatized patient with unrecognized pneumothorax after blunt chest trauma is reported.

SUMMARY OF BACKGROUND DATA

In most cases, intraspinal air is associated with degenerative disc disease, epidural abscess, or synovial cyst, or it follows iatrogenic manipulation. Scialdone and Wagle first reported a case of intraspinal air due to a laceration of the right main bronchus. No previous case of intraspinal air after a simple unsuspected pneumothorax following blunt chest trauma has been reported.

METHODS

During routine x-ray and computed tomography examination of a polytraumatized patient, an unsuspected pneumothorax due to a rib fracture was detected in a thorax computed tomography scan. Computed tomography scans of the cervical spine showed a collection of intraspinal air.

RESULTS

The computed tomography examination of a polytraumatized patient with an unsuspected pneumothorax after blunt chest trauma showed the embolization of air in the paravertebral vein plexus and in the intraspinal canal.

CONCLUSION

These observations suggest a wider indication for computed tomography scans of the thorax in blunt chest trauma. Also, whenever intraspinal air is found in the diagnostic course of a traumatized patient, a hidden pneumothorax should be suspected and ruled out.

[Estimating patient dose in radiologic examinations using conversion factors]

The principles for estimation of the patient's radiation dose from conventional radiographic and computed tomography examinations are presented on the basis of published exposure simulation data. The relationship between absorbed dose in air, or axis dose, organ doses, and effective dose is explained. It is shown how organ doses can be calculated from the absorbed dose free in air or axis dose using published computed conversion factors. Calculation of the effective dose from organ doses using tissue weighting factors is described. Finally, examples of dose calculation are given for a conventional radiographic and a CT examination.

Multiple (five) synchronous primary malignant neoplasms of dissimilar histogenesis including a malignant fibrous histiocytoma of the bladder

A unique case was recently encountered involving the synchronous presentation of five primary malignancies of different histology. Malignant neoplasms of the colon, kidney, prostate and bladder were treated surgically. Bladder was affected by two separate tumours: a transitional cell carcinoma and a malignant fibrous histiocytoma. The latter constitutes an extremely rare malignant lesion of the organ. The pathologic characteristics, histogenesis, differential diagnosis and treatment considerations of this soft tissue sarcoma, and the incidence, terminology and incriminating factors of multiple primary malignant neoplasms, as well as their association with the genitourinary system are reviewed.

[Estimating patient dosage in radiologic examinations. Effective doses of the most frequent roentgen examinations]

The effective dose (E) measures the stochastic risk of radiation exposure from the viewpoint of the induction of cancer and genetic diseases. In order to compare this risk in roentgen examinations, the effective dose was calculated for the most frequent roentgen examinations. The calculations were performed with a mathematical human phantom for a standard patient. Acquisition parameters were chosen according to national recommendations. The highest values were found for the small bowel enema and lumbar myelography, the lowest values for X-rays of the cervical spine, the paranasal sinuses and the upper thigh.

Identification of the Agrobacterium tumefaciens C58 T-DNA genes e and f and their impact on crown gall tumour formation

DNA sequence analysis of the 4.4 kilobases (kb) Eco RI fragment 14 from T-DNA of Agrobacterium tumefaciens C58 revealed three open reading frames. One of them (945 bp) was supposed to encode the transcript e, the function of which has not been identified to date. Furthermore, a so far undescribed open reading frame (1035 bp) was identified, located in the centre of the Eco RI fragment 14 and termed gene f. The third open reading frame encoded the carboxy-terminal part of the agrocinopine synthase (Acs). The gene e-encoded protein showed significant homologies to the gene products of the Agrobacterium rhizogenes rolB gene and the Agrobacterium tumefaciens gene 5. Both gene products are supposed to regulate the plant's reaction on auxin. Depending on the plant species tested, Agrobacterium strains carrying mutations in gene e induced only small or almost no detectable crown gall tumours. According to these mutational studies and the protein homologies observed, the gene e product is suggested to be involved in tumour formation. Infection of several plant species with Agrobacterium carrying a mutated gene f, as well as expression of the gene f in transgenic tobacco plants did not lead to visible morphological changes. Therefore, in contrast to gene e, the gene f seems not to be essential for tumour formation. In order to study whether gene f is an active gene, its expression in agrobacteria and plants was monitored by translational lacZ fusion. In planta, the putative gene f-promoter mediates a tissue-specific expression pattern. Although gene f was expressed in free-living agrobacteria as well as in transgenic plants, the function of the f locus remained unclear. DNA homology studies with the f gene region revealed a mosaic-like DNA structure, indicating that this locus might be the result of genetic exchanges between different Agrobacterium strains during evolution.

Primary osteosarcoma of the kidney. Case report and review of literature

Primary osteosarcoma of the kidney is an extremely rare phenomenon with less than 20 previously reported cases in the English literature since 1936. Diagnosis usually is made in advanced stages of disease with weight loss, palpable tumor, flank pain and gross hematuria being the characteristic features of clinical presentation. Radiographically bizarre renal calcifications may be suggestive of this uncommon neoplasm. The atypic location is explained by metaplastic changes of originally primitive embryonic mesenchymal tissue. Though the primary treatment for sarcomas is surgical resection, because of their usual late and high stage presentation multimodal adjuvant therapy may be desirable. We describe the clinical course of a 48-year-old male patient with a primary renal osteosarcoma discovered by ultrasound. A marked reduction of vital tumor cells and an impressive increase of neoplastic bone formation following polychemotherapy is demonstrated histopathologically. The principal clinical findings, differential diagnosis, etiology, pathogenesis and treatment modalities of this uncommon malignancy are discussed.

[Cerebral arteriovenous angiomas: 3-dimensional demonstration by spiral CT]

In 20 patients with known or suspected supratentorial arteriovenous malformations, an attempt was made to see how far CT angiography with 3-dimensional reconstructions is able to make a diagnosis and to differentiate the various components of the angioma. Spiral CT was performed following an intravenous bolus injection of 60-80 ml of iodine containing contrast medium. In all patients the diagnosis was confirmed by intra-arterial DSA of the vertebral vessels. In 13 patients, av malformations could be diagnosed following multiplanar 3-D reconstructions which agreed with the findings on DSA. The large supplying vessels, the nidus and the large draining veins could be defined with certainty. In 6 patients follow-up examination after embolisation was performed. The results could be demonstrated in three dimensions and the success of treatment could be documented unequivocally. CT angiography with 3-D reconstruction is able to supply important information in the majority of intracranial av malformations, both during initial investigation and following treatment.

[The spiral CT of orbital space-occupying lesions: improved imaging possibilities via freely reconstructible planes]

In a prospective study the value of spiral CT for the detection and differential diagnosis of intraorbital masses was investigated. Thirty patients with various orbital diseases were examined with transverse spiral computed tomography. After performing two contiguous 1 mm spiral CT scans, coronal, parasagittal, and other reconstructions were obtained. Compared with separately generated 2 mm slices, the 1 mm spiral CT images showed a slightly decreased signal-to-noise ratio, but due to the better spatial resolution, the image quality of secondary reconstructions was similar to that of the original transverse spiral CT slices. Generally the orbital masses were visualized best in the coronal reconstruction. In certain cases, the parasagittal reconstructions were superior. Reconstructions in freely definable slice planes based on 1 mm spirals provides better visualization of orbital diseases without increasing radiation dose. This method allows multiplanar reconstructions similar to magnetic resonance tomography.

Granulocyte colony-stimulating factor prophylaxis before operation protects against lethal consequences of postoperative peritonitis

BACKGROUND

Postoperative peritonitis has a high mortality in human beings. It is accepted that cytokines are important mediators in pathophysiology of sepsis. The recent failure of clinical trials increased the necessity to proof new drugs in more clinically relevant animal models. The aim of this study was to examine the effect of granulocyte colony-stimulating factor (G-CSF) in addition to an antibiotic in postoperative peritonitis.

METHODS

Dose-response curves and experimental conditions were developed in a total of 295 rats. The main experiment included three groups: control animals receiving a fecal inoculum, a group treated with antibiotic, and a third group receiving G-CSF in addition to the antibiotic. The main outcome was death, but in addition, serum tumor necrosis factor (TNF) level was determined.

RESULTS

The mortality rate of 60% in antibiotic treated animals was considerably reduced by G-CSF to 20%. All animals of the control group died during the observation period of 120 hours. A correlation between TNF levels and mortality rate was observed. In G-CSF treated animals total suppression of TNF serum levels was accessible in contrast to the others.

CONCLUSIONS

In a clinically relevant animal model G-CSF was effective as an additional concept of prophylaxis. These data are promising toward clinical trials.

Clinical, radiological and histological findings in desmoplastic infantile ganglioglioma

The clinical course and radiological and histological findings in a 30-month-old boy suffering from desmoplastic infantile ganglioglioma are reported. The child's development was normal until a series of complex partial seizures occurred at the age of 7 months. Cranial computed tomography and magnetic resonance imaging revealed a cystic mass with intensive ring-shaped contrast enhancement in the right temporal fossa without shift of intracranial structures. Histologically, the firm, grayish tumor showed an enormous amount of connective tissue, cystic areas, and some mitoses. Glial and neuronal cell lines were identified by immunocytochemical methods. Eighteen months after surgery the boy had developed well without any neurological dysfunction; no radiation or chemotherapy was given. For the first time a synopsis of radiological findings in this rare brain tumor is correlated with the results of multiple histological and immunocytochemical studies. Despite some malignant characteristics, the prognosis of this dysontogenetic brain tumor is good.

Successful allotransplantation of microencapsulated parathyroids in rats

Allotransplantation of parathyroid tissue in humans is desirable for treating long-term hypoparathyroidism (e.g., after inadvertent removal of parathyroid glands during thyroid surgery). Until now, parathyroid allotransplantation was not used clinically because its advantages were outweighted by the need of immunosuppression. To overcome the immunogenicity of the tissue to be transplanted, we employed the method of microencapsulation; first tried in islet cell transplantation for experimental allotransplantation of parathyroid tissue. We have been able to achieve long-term success in a rat model. After isolation and tissue culture, tissue pieces from parathyroid glands of 280 Lewis rats were encapsulated in barium alginate and grafted into hypocalcemic DA rats. From the 7th to the 90th day after transplantation the recipient rats (DA rats) showed a normal serum calcium concentration. This is the first report of successful long-term survival and function of microencapsulated allotransplanted parathyroid tissue.

[Osteoplastic bone metastases in prostatic carcinoma: magnetic resonance tomography and bone marrow scintigraphy]

MRI of the vertebral column was performed in 28 patients with histologically confirmed prostate carcinoma. Besides routine spin-echo sequences all patients were examined with gradient-echo sequences using the chemical shift mode. In addition, in all patients bone marrow scintigraphy (BMS) was performed, and all results were compared with routine bone scan (BS). In our study BMS was not superior to bone scan. In contrast, MRI scan revealed solitary metastases in two patients with negative BS and BMS. Osteoplastic metastases showed a contrast enhancement in the MRI and could be distinguished from benign alterations.

Long term results of unicondylar fractures of the femur

Twenty-four unicondylar fractures of the distal femur were treated at the Trauma Center "Bergmannsheil," University of Bochum, Germany, between 1981 and 1990. All patients sustained their injuries from severe direct trauma. There were 16 lateral condylar fractures, five medial condylar fractures, and three tangential posterior ("Hoffa-type") fractures. Twenty-three closed injuries and one grade IIIB open fracture are included. Nine patients (37.5%) sustained concomitant injuries to the skeleton. All fractures were treated with open reduction and internal fixation with screws within 8 h of admission. Postoperative management consisted of early continuous passive motion and minimal weight bearing for 6-8 weeks progressing to full weight bearing. The mean follow-up was 62 months (24-120). The therapeutic outcome (clinical result, radiographs) was rated by the Neer score. Twenty patients were rated excellent, three achieved satisfactory results, and one had an unsatisfactory result. All patients without an excellent outcome had accompanying injuries. Open reduction and internal screw fixation of unicondylar femur fractures provides overall excellent long-term results. The therapeutic outcome is significantly affected by associated injuries of the skeleton.

Localisation of hyaluronate (HA) in primary tumors and nude mouse xenografts of human pancreatic carcinomas using a biotinylated HA-binding protein

A biotinylated hyaluronate (HA)-binding protein isolated from bovine cartilage was used to analyze the distribution of HA in nude mouse xenografts derived from human pancreatic adenocarcinoma cell lines as well as in primary human pancreatic adenocarcinomas. The most reproducible results for the localisation of HA were obtained using cryostat sections. When the biotinylated HA-binding protein was applied to histological sections of nude mouse xenografts, the specific staining found could be inhibited by preincubating the HA-binding protein with an excess of HA or by hyaluronidase treatment of the tissue before staining. The highest HA concentration was found at the tumor boundaries, while in the central part of the tumor staining was slight or absent. In cryostat sections of primary tumors HA was found predominantly in the connective tissue immediately around tumor cells or at the border between the tumor and normal pancreatic tissue.

Expression and distribution of VLA receptors in the pancreas: an immunohistochemical study

Very late activation (VLA) receptors mediate cell adhesion to extracellular matrix, mainly by acting as adhesion receptors to fibronectin, collagen, and laminin as well as to other cells. These interactions not only regulate normal cell-extracellular matrix contact, but also are thought to be involved in metastasis and invasive tumor growth. Using immunohistochemistry [the alkaline phosphatase-anti-alkaline phosphatase (APAAP) technique] we compared the expression and distribution of VLA receptors in normal pancreatic tissue, chronic pancreatitis, and ductal pancreatic adenocarcinoma. Immunohistochemically, VLA alpha 2 and VLA alpha 6 were moderately to strongly expressed on the basal surface of ductal and acinar cells in normal pancreatic tissue, whereas centroacinar cells predominantly expressed VLA alpha 3 and VLA alpha 5. Similarly, pancreatic carcinoma showed an intensive staining for VLA alpha 2 and VLA alpha 6 with a diffuse distribution on the cell surface. Expression of VLA alpha 3 and VLA alpha 5 in pancreatic carcinoma was heterogeneous, ranging from moderate to weak and lost in about 50% of the cells. As our results suggest, cell-basement membrane interaction in ductal and acinar pancreatic cells is primarily mediated through VLA alpha 2 and VLA alpha 6, whereas VLA alpha 3 and VLA alpha 5 are the major VLA receptors on centroacinar cells. In pancreatic carcinoma a loss (VLA alpha 5) or redistribution (VLA alpha 2, VLA alpha 6) of VLAs was observed. This redistribution of VLA alpha 2 and VLA alpha 6 may reflect a loss of spatial arrangement of tumor cells and their ability to randomly interact with extracellular matrix structures during invasion and metastasis.

[Diffuse demineralization of the lumbar spine. Magnetic resonance tomography studies of osteoporosis and plasmacytoma]

On plain radiographs, diffuse infiltration of the spine in multiple myeloma may present as diffuse demineralization. Differentiation from osteoporotic changes is then difficult. 15 patients with multiple myeloma and 15 patients with osteoporosis were prospectively examined by MRI using plain and contrast enhanced gradient echo techniques. Examinations were evaluated for lesions and diagnosis was made by two independent observers. Contrast enhancement was visible in lesions detected in myeloma patients and in compression fractures. Fractures could be differentiated from malignant lesions by the fact that there was no multiplicity of enhancing lesions. Contrast enhanced opposed phase gradient echo sequences seem suited for the detection of vertebral involvement in myeloma.

Generalised giant-cell tumour of bone: successful treatment of pulmonary metastases with interferon alpha, a case report

We report on a 37-year-old female patient with generalised giant-cell tumour of the bone, whose tumour was refractory to conventional chemotherapy. Subsequent treatment with interferon alpha 2a in increasing dosage from 4 x 10(6) IU (three times a week) to 9 x 10(6) IU (three times a week) led to a significant decrease of pulmonary metastases and a stabilisation of the disease after 12 months of treatment. In progressive chemotherapy refractory giant-cell tumour interferon alpha 2a may be of therapeutic benefit.

[Arterial vascular injuries in fractures or dislocations of the lower extremity. Therapeutic concept and results]

Combinations of fractures or dislocations with vascular damage of the leg have a high incidence of amputation or severe functional deficit. With this type of lesion 22 patients were treated at "Bergmannsheil" from 1986 to 1991. Using a pre-, intra- and postoperative protocol, the amputation rate decreased to 18%. More than 80% of the patients had a good function of their leg with only minor joint restrictions.

[Atypical hyperplasia of the prostate: coincidence with invasive carcinoma. A study of 69 prostatectomy preparations]

In a series of 69 prostatectomy specimens, including 62 invasive carcinomas, we studied the prevalence of atypical hyperplasia of small acinar, large acinar and cribriform type, diagnosed according to the criteria of J. Kovi, 1989. The study was performed on serial whole sections of 5 mm thick slices. As a result, the association of atypical large acinar hyperplasia with small acinar or cribriform atypical hyperplasia was significantly increased in cases with coincidental carcinoma. Furthermore, atypical cribriform hyperplasia was almost exclusively found in cases with cribriform or solid type of invasive carcinoma.

New instruments for high throughput receptor binding assays

The TopCount Microplate Scintillation Counter and the Matrix 9600 Direct Beta Counter are microplate compatible instruments developed to meet the needs of investigators using radioisotope assays adapted for very high throughput. This paper describes these instruments and their application to receptor binding assays. When combined with the appropriate sample handling equipment and filter media, use of these multi-detector instruments improves sample handling efficiency and shortens overall counting time. The assay protocols including filtration through glass fiber mats and membrane filters have been investigated. Results obtained from these new instruments are compared to standard techniques using conventional liquid scintillation and gamma counting.

Expression and function of VLA-alpha 2, -alpha 3, -alpha 5 and -alpha 6-integrin receptors in pancreatic carcinoma

The expression of the VLA-integrins alpha 2, alpha 3, alpha 5 and alpha 6 was studied immunohistochemically in tissue samples from ductal pancreatic cancer, chronic pancreatitis, normal pancreas and in 8 cell lines of ductal human pancreatic cancer. Furthermore, adhesion assays on purified extracellular matrix (ECM)-compounds were used to define the function of alpha 2, alpha 3, alpha 5 and alpha 6 in pancreatic cancer cells. Immunohistochemically, VLA alpha 2 and VLA alpha 6 were moderately to strongly expressed on the basal surface of ductal and acinar cells in normal pancreatic tissue, while centro-acinar cells predominantly expressed VLA alpha 3 and VLA alpha 5. Pancreatic carcinoma showed intense staining for VLA alpha 2 and VLA alpha 6 with a diffuse distribution on the cell surface. The redistribution of VLA alpha 2 and VLA alpha 6 may reflect a loss of spatial arrangement of tumor cells and their ability to interact randomly with extracellular matrix structures during invasion and metastasis. Expression of VLA alpha 3 and VLA alpha 5 in pancreatic carcinoma was heterogeneous, ranging from moderate to weak, and was lost in about 50% of the cells. Two pancreatic carcinoma cell lines (PC 3, PC 44) were further investigated in adhesion assays. Monoclonal antibodies (MAbs) against alpha 2 (GI 9, 10-G-11) were able to inhibit tumor-cell adhesion to collagen IV (59%-72%) in both cell lines. A MAb against alpha 6 (GoH3) inhibited tumor-cell adhesion to laminin (52%-86%) in both cell lines. These results suggest that alpha 2 is a collagen-binding site and alpha 6 a laminin-binding site in pancreatic cancer cells. The anti-alpha 5-MAb SAM I inhibited adhesion of PC3 to fibronectin (76%), being without effect in PC44. Adhesion of both cell lines to fibronectin was almost completely inhibited by RGDS (85%-88%). Thus, alpha 5 is a functionally important fibronectin binding site in some pancreatic carcinoma cells, suggesting further RGD-dependent fibronectin binding sites in other pancreatic carcinoma cells.

Quantification of tissue distribution of antibiotics by kinetic hysteresis analysis

Distribution of antibiotics can be described by kinetic hysteresis analysis when concentrations are measured in the serum and an extravascular sampling site. By calculating the area of the hysteresis loop (a simple formula is presented), the relative amount of drug transferred to an extravascular site can be quantified. With this approach, changes in disposition characteristics can be evaluated under various pathophysiological conditions. In addition, a specific distribution coefficient may be derived for any drug when different dose levels are studied under identical conditions. Kinetic hysteresis analysis overcomes the drawback of conventional compartment model pharmacokinetic analysis, since no simultaneous fitting of two different concentration-time courses is feasible.