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Spodeck D, Guder W, Streitbürger A, Dudda M, Podleska LE, Nottrott M, Hardes J. Pathological Fractures in Benign Bone Lesions - Diagnosis and Therapy. Z Orthop Unfall 2024; 162:69-78. [PMID: 35882354 DOI: 10.1055/a-1850-2540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Most tumour-related pathological fractures occur in patients with bone metastases. However, in mostly younger patients, a pathological fracture can be due to both a benign or a malignant bone tumour. Making the correct diagnosis from among these two differential diagnoses is enormously important. If the tumour is malignant, treating the fracture inevitably leads to tumour cell contamination and can significantly worsen the oncological situation. The aim of this review article is firstly to provide the reader with diagnostic assistance in the case of suspected pathological fractures, and secondly to focus on the treatment of pathological fractures occurring with benign bone tumours. METHODS This is a non-systematic review of the diagnosis and treatment of pathological fractures in benign bone tumours or tumour-like lesions, based on an electronic PubMed database search. We also present our own procedures, in particular for ruling out a malignant bone tumour. RESULTS AND DISCUSSION Whenever a fracture occurs in the absence of sufficient traumatic force, the possibility of a pathological fracture should always be considered. As well as taking a general history for a possible primary tumour, it is particularly important to ask the patient whether they had any pain before the fracture occurred. If the findings from clinical examination or conventional radiological imaging give rise to suspicion of a pathological fracture, an MRI of the affected skeletal section with contrast medium should be carried out before commencing any fracture treatment. A CT scan is also helpful for accurately assessing bone destruction. If a malignant or locally aggressive benign bone tumour such as giant cell tumour (GCT) or aneurysmal bone cyst (ABC) cannot be definitively ruled out through imaging, a biopsy is essential. The bone biopsy must always be carried out on the assumption that the histological work-up will reveal a malignant bone tumour; it must therefore be performed according to strict oncological criteria. If the radiological diagnosis is unambiguous, e. g., a juvenile bone cyst (JBC) or a non-ossifying fibroma (NOF), conservative treatment of the fracture can be considered, depending on the location. In the presence of a locally aggressive benign bone tumour such as a GCT or ABC, curettage of the tumour must be carried out as well as treating the fracture. With GCT in particular, neoadjuvant therapy with denosumab prior to curettage and osteosynthesis or en bloc resection of the tumour should be considered, depending on the extent of the tumour. CONCLUSION Pathological fractures, especially in younger patients, should not be overlooked. Only after a malignant or benign locally aggressive bone tumour has been definitively ruled out should fracture treatment be performed. In the presence of a locally aggressive bone tumour, as well as treating the fracture, it is usually necessary to perform curettage of the tumour - also en bloc resection, where applicable, in the case of a GCT. Depending on the location, benign, non-aggressive tumours can be treated conservatively if necessary.
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Affiliation(s)
- Daniel Spodeck
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Wiebke Guder
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Essen, Deutschland
| | - Arne Streitbürger
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Essen, Deutschland
| | - Marcel Dudda
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Universität Duisburg-Essen, Duisburg, Deutschland
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Lars Erik Podleska
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Essen, Deutschland
| | - Markus Nottrott
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Essen, Deutschland
| | - Jendrik Hardes
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Essen, Deutschland
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Mester B, Burggraf M, Beck P, Meyer HL, Polan C, Albrecht T, Guder W, Streitbürger A, Dudda M, Hardes J. Cortical Desmoid of the Distal Femur-Incidentaloma or Insertional Tendinopathy? J Clin Med 2023; 12:jcm12082969. [PMID: 37109304 PMCID: PMC10145125 DOI: 10.3390/jcm12082969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/10/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The cortical desmoid (DFCI) of the posteromedial femoral condyle is considered an asymptomatic incidental finding in adolescents without clinical relevance. The aim of this study was to evaluate the clinical relevance of DFCI from both a tumor orthopedic and sports medicine point of view. METHODS n = 23 patients (13.74 ± 2.74 years; nineteen female, four male) with DFCI of the posteromedial femoral condyle were included. A localized posteromedial knee pain on exertion was differentiated from non-specific knee pain. Symptom duration, additional pathologies, number of MRIs, sports activity and training intensity, downtime, therapeutic modalities, and relief/remission of symptoms were documented. The Tegner activity scale (TAS) and Lysholm score (LS) were collected. The influence of specific posteromedial pain, MRI presence of paratendinous cysts, sports level as well as physiotherapy on downtime and LS/TAS was statistically analyzed. RESULTS 100% reported knee symptoms at initial presentation. A localized posteromedial pain was documented in 52%. In 16/23 (70%) additional functional pathologies were diagnosed. Patients were physically highly active with high training intensities (6.52 ± 5.87 h/week) and performance level (65% competitive vs. 35% recreational). Patients underwent 1.91 ± 0.97 MRIs (max four). Symptom duration was 10.48 ± 11.02 weeks. A follow-up examination was performed after 12.62 ± 10.41 months (n = two lost to follow-up). 17/21 had physiotherapy, on average 17.06 ± 13.33 units. Overall downtime was 13.39 ± 12.50 weeks, the return-to-sports (RTS) rate 81%. 100%/38% reported a relief/remission of complaints. LS was 93.29 ± 7.95, median TAS before onset of knee complaints/at follow-up 7 (6-7)/7 (5-7). Specific posteromedial pain, presence of paratendinous cysts, sports level and physiotherapy had no significant influence on downtime and outcome parameters (n.s.). CONCLUSIONS DFCI as a pathognomonic finding is recurrently encountered in the MRIs of children and adolescents. This knowledge is essential to spare patients from overtreatment. Contrary to the literature, the present results implicate a clinical relevance of DFCI particularly in those who are physically highly active with localized pain on exertion. Structured physiotherapy as basic treatment is recommended.
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Affiliation(s)
- Bastian Mester
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Manuel Burggraf
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Paula Beck
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Heinz-Lothar Meyer
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Christina Polan
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Thomas Albrecht
- Department for Tumor Orthopedics, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Wiebke Guder
- Department for Tumor Orthopedics, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Arne Streitbürger
- Department for Tumor Orthopedics, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Marcel Dudda
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
- Department for Orthopedics and Trauma Surgery, BG-Klinikum Duisburg, University of Duisburg-Essen, Großenbaumer Allee 250, 47249 Duisburg, Germany
| | - Jendrik Hardes
- Department for Tumor Orthopedics, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
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Stork T, Hegedüs B, Guder W, Hamacher R, Hardes J, Kaths M, Plönes T, Pöttgen C, Schildhaus HU, Streitbürger A, Treckmann J, Bauer S, Aigner C, Collaud S. Prognostic Factors for Leiomyosarcoma with Isolated Metastases to the Lungs: Impact of Metastasectomy. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11806-8. [PMID: 35552929 PMCID: PMC9174305 DOI: 10.1245/s10434-022-11806-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Leiomyosarcoma (LMS) most frequently metastasizes to the lung. Metastatic LMS is considered incurable. Selected patients may benefit from pulmonary metastasectomy (PM) within multimodal therapy. This study analyzed the prognostic relevance of clinicopathologic factors in these patients. METHODS Patients with metastatic LMS to the lung treated in our center from 2004 to 2020 were included in this single-center retrospective study. Overall survival (OS), progression-free survival (PFS), and prognostic factors were analyzed. RESULTS The study had 64 patients (33 males, 52%) with metastatic LMS to the lung. The 5-year OS was 55% after the diagnosis of pulmonary metastases. Age older than 60 years at the primary tumor diagnosis, primary tumor larger than 70 mm, and five or more lung metastases were associated with poorer OS. Of the 64 patients, 44 underwent PM. The postoperative mortality rate was 0%. The patients selected for PM were younger and had smaller primary tumors, fewer metastases, and metastases that more often were metachronous. Metastasis grade (G1 vs. G2/3) and size (20-mm cutoff) were significant prognostic factors for OS (p = 0.05) and PFS (p = 0.028) after PM, respectively. The 44 patients who underwent PM had a survival benefit compared with the patients who were selected but did not undergo PM (n = 6) and the patients who were not selected for PM (n = 14). Three patients (7%) were alive and free of disease at the last follow-up visit respectively 5.5, 9, and 12 years after PM. CONCLUSIONS For patients with leiomyosarcoma, PM is safe. Despite aggressive multimodal treatment, most patients will experience recurrence and eventually die of their disease. However, a small subgroup of patients could potentially be cured after PM.
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Affiliation(s)
- Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
| | - Balazs Hegedüs
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
| | - Wiebke Guder
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rainer Hamacher
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jendrik Hardes
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Moritz Kaths
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Till Plönes
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
| | - Christoph Pöttgen
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hans-Ulrich Schildhaus
- German Cancer Consortium (DKTK), Center Essen, Germany
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Arne Streitbürger
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Tumor Orthopedics and Sarcoma Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Juergen Treckmann
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sebastian Bauer
- German Cancer Consortium (DKTK), Center Essen, Germany
- Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany.
- German Cancer Consortium (DKTK), Center Essen, Germany.
| | - Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Center Essen, Germany
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Mester B, Guder W, Streitbürger A, Schoepp C, Nottrott M, Podleska L, Dudda M, Hardes J. Return to Sports and Activity in Tumor Orthopaedics. Z Orthop Unfall 2021. [PMID: 34879419 DOI: 10.1055/a-1676-5266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION As survival rates associated with the multimodal treatment of malignant bone cancer (osteosarcoma and Ewing's sarcoma) are satisfactory, health-related quality of life and the return to activity and sports by the affected patients have attracted increasing attention in recent years. Nowadays, limbs can be salvaged for most patients using modular endoprostheses. Such patients are typically adolescents and young adults who have high activity levels and thereby high demands for multimodal cancer treatment. This study aimed to evaluate the activity levels and sporting proficiencies that can be attained after modular endoprosthetic treatment of bone sarcomas as well as the extent to which physiotherapeutic and sports interventions influence functional outcome and activity levels. METHODS This non-systematic review of the literature focused on the return to activity and sports after modular endoprosthetic treatment of lower extremities bone sarcomas in adolescents and young adults. The electronic database PubMed was screened for relevant publications on this issue. A treatment algorithm for return to activity and sports in tumor orthopaedics is proposed. RESULTS AND DISCUSSION The objective activity level (gait cycles per day and gait intensities) in patients treated for bone sarcomas is reduced in short- and long-term follow-ups compared with healthy controls and patients with other cancers (leukaemia). Although a negative impact is observed in terms of motor performance, it shows improvement over time. Functional assessment at 12 postoperative months is sensible as neoadjuvant chemotherapy is completed by then. In long-term follow-up, patients with bone sarcomas can achieve high sports activity levels, i.e., type of sport, frequency/week and UCLA score, after modular endoprosthetic reconstruction. The maximum level is attained at 5 years postoperatively. Nevertheless, there is a shift from high- and intermediate- to low-impact sports. Only 20% of the patients participate in school sports regularly without limitations. The localisation of bone sarcoma, but not the rate of postoperative complications, influences the postoperative activity level. Individualised sports-related interventions during and after multimodal treatment can improve the short-term activity levels; moreover, "serious games" can improve motor performance and postural control. There is no evidence that intense activity levels leads to early loosening of the endoprosthesis. There is insufficient valid data on activity and sports after modular endoprosthetic treatment of bone sarcomas of the upper extremities. CONCLUSION High preoperative activity levels of young patients with bone sarcomas must be considered in tumour orthopaedics. Limitations on sports activities have a significant negative impact on the quality of life and mental health of such patients. Therefore, tumour orthopaedic treatment has to focus on preserving an improvement in these factors. The overall existing evidence concerning this issue is weak. Additional studies to evaluate the ability to return to specific sports activities are desirable, as well as prospective interventional studies.
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Affiliation(s)
- Bastian Mester
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Wiebke Guder
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Arne Streitbürger
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Christian Schoepp
- Klinik für Arthroskopische Chirurgie, Sporttraumatologie und Sportmedizin, BG Klinikum Duisburg, Universität Duisburg-Essen, Duisburg, Deutschland
| | - Markus Nottrott
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Lars Podleska
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Marcel Dudda
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Universität Duisburg-Essen, Duisburg, Deutschland.,Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Jendrik Hardes
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
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Abstract
Pathological tumor-associated fractures are overall rare. They can occur in every age group and every bone. Although tumor-related fractures only form a small proportion of bone fractures, the early recognition of the cause of the fracture and treatment according to oncological guidelines are of enormous importance for affected patients. False treatment is frequently associated with far-reaching negative consequences with respect to the course of the disease. The great challenge is not the expeditious surgical treatment but much more the adequate diagnostics and the incorporation of local fracture treatment into an interdisciplinary overall oncological concept.
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Affiliation(s)
- Arne Streitbürger
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Markus Nottrott
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Wiebke Guder
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Lars Podleska
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Marcel Dudda
- Klinik für Unfall‑, Hand-, und Wiederherstellungschirurgie, Universitätsmedizin Essen, Essen, Deutschland
| | - Jendrik Hardes
- Klinik für Tumororthopädie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Heinemann M, Hoffmann C, Hardes J, Guder W, Streitbürger A, Götte M, Welz TL, Jürgens H, Ranft A, Vieth V, Weckesser M, Schäfers M, Stegger L, Dirksen U. Pain in survivors of Ewing sarcoma: Prevalence, associated factors and prediction of recurrence. Pediatr Blood Cancer 2021; 68:e28801. [PMID: 33179838 DOI: 10.1002/pbc.28801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/15/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND While the prognosis of patients with Ewing sarcoma (EwS) is improving, little is known about the frequency of pain and its risk factors in survivors of EwS. This study aims to analyse the prevalence and risk factors of pain and its predictive value for recurrence. PATIENTS AND METHODS In patients with remission after treatment of EwS, frequency and characteristics of pain within the first 5 years of follow up were assessed retrospectively. RESULTS Of 80 patients, 37 (46%) presented with at least one episode of pain. Chronic pain (>3 months) was observed in 10 patients (13%). Experience of at least one episode of pain was associated with prior combined local treatment (surgery and radiation compared to surgery alone; odds ratio [OR] 5.83, 95% confidence interval [CI] 1.43-34.9, P = .007). A total of 59 episodes of pain were observed, including 47 acute and 12 chronic episodes. Lower limb pain accounted for 46% (27/59) of all episodes of pain, and was associated with primary tumour of the pelvis or lower extremity (OR 4.29, 95% CI 1.18-18.21, P = .025), which represented 64% (51/80) of all EwS. The positive predictive value of pain for recurrence was only 12%. CONCLUSION Pain is a common problem in survivors of EwS, which mostly affects the lower extremity, and should be regularly assessed. Interventions to reduce pain may be particularly important in patients with combined local treatment with surgery and radiation, who seem to be at considerably increased risk for pain. Patients presenting with pain should be examined for recurrence.
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Affiliation(s)
- Melina Heinemann
- Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Department of Paediatric Haematology and Oncology, University Hospital Münster, Münster, Germany.,Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Christiane Hoffmann
- Orthopaedic Hospital Volmarstein, Wetter, Germany.,Department of Orthopaedics and Tumour Orthopaedics, University Hospital Münster, Münster, Germany
| | - Jendrik Hardes
- Department of Orthopaedics and Tumour Orthopaedics, University Hospital Münster, Münster, Germany.,Department of Oncologic Musculoskeletal Surgery, University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Wiebke Guder
- Department of Orthopaedics and Tumour Orthopaedics, University Hospital Münster, Münster, Germany.,Department of Oncologic Musculoskeletal Surgery, University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Arne Streitbürger
- Department of Orthopaedics and Tumour Orthopaedics, University Hospital Münster, Münster, Germany.,Department of Oncologic Musculoskeletal Surgery, University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Miriam Götte
- Department of Paediatric Haematology and Oncology, University Hospital Münster, Münster, Germany.,Paediatrics III, University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Theresa Luisa Welz
- Paediatrics III, University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Heribert Jürgens
- Department of Paediatric Haematology and Oncology, University Hospital Münster, Münster, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Andreas Ranft
- Department of Paediatric Haematology and Oncology, University Hospital Münster, Münster, Germany.,Paediatrics III, University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Volker Vieth
- Department of Radiology, University Hospital Münster, Münster, Germany.,Department of Clinical Radiology, Klinikum Ibbenbüren, Ibbenburen, Germany
| | - Matthias Weckesser
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Lars Stegger
- Department of Nuclear Medicine, University Hospital Münster, Münster, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany
| | - Uta Dirksen
- Department of Paediatric Haematology and Oncology, University Hospital Münster, Münster, Germany.,Paediatrics III, University Hospital Essen, Essen, Germany.,West German Cancer Centre (WTZ) Network, Essen and Muenster, Germany.,DKTK, German Cancer Research Centre, Essen, Germany
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Hardes J, Guder W, Streitbürger A, Podleska L, Rödder P, Täger G, Dudda M, Nottrott M. [Treatment concepts for complications after resection and defect reconstruction of pelvic tumours]. Orthopade 2020; 49:133-141. [PMID: 31996946 DOI: 10.1007/s00132-020-03882-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Partial pelvic resection, internal hemipelvectomy or sacrectomy as a result of bone sarcoma is still challenging. No matter what kind of reconstruction is used, there is still a much higher rate of complications in pelvic surgery compared to sarcoma surgery of the long bones. OBJECTIVES We describe the most common complications in pelvic sarcoma surgery and specific complications related to the reconstruction method. Handling strategies for these complications are specified. METHODS We performed a literature search and report our own experiences in the troubleshooting of pelvic surgery-related complications to gain an up-to-date overview of the state-of-the-art in management strategies. RESULTS Prospective randomized trials or meta-analyses on this topic are lacking. The literature search depicted that, besides local recurrence, deep infection after reconstruction is the most serious complication. An early revision with radical debridement has to be performed in order to save the reconstruction. In the case of a deep infection, the removal of all implants with a total loss of the reconstruction is often unavoidable. Therefore, an individualized risk-benefit analysis prior to surgery with respect to the type of reconstruction, or no reconstruction at all (hip transposition), together with the patient is advisable. CONCLUSIONS Complications-especially infections-after hemipelvectomy or sacrectomy are common. In the case of infection, in some cases, an early revision is the only chance to prevent a reconstruction from explantation.
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Affiliation(s)
- J Hardes
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - W Guder
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - A Streitbürger
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - L Podleska
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - P Rödder
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - G Täger
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - M Dudda
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - M Nottrott
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Guder W, Nottrott M, Streitbürger A, Röder J, Podleska LE, Scheidt P, Dudda M, Hardes J. [Complication management following resection and reconstruction of the upper limbs and shoulder girdle]. Orthopade 2020; 49:104-113. [PMID: 31974633 DOI: 10.1007/s00132-020-03874-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sarcomas of the upper limbs commonly affect the proximal humerus or scapula. Complications after tumor resection and reconstruction are rare but cannot be neglected, particularly after tumor endoprosthetic reconstructions. MATERIALS AND METHODS The most common complications after resection of sarcomas of the upper limbs and shoulder girdle are described, and current knowledge regarding complication management is presented. Additionally, a selective literature search was performed, incorporating personal experiences. RESULTS Wound healing disorders and infections after tumor resection without specific reconstruction (clavicle resection, scapulectomy) usually respond well to conservative or surgical treatment. However, periprosthetic infections after reconstruction using a megaendoprosthesis constitute a severe and frequent complication, with an incidence of 5-10%. Two-stage implant replacement still represents the gold standard, although in selected cases, one-stage revision with retention of the prosthetic stem appears warranted. Secondary amputation as a result of periprosthetic infection is rare compared to the situation with infections of the lower limb. Mechanical complications necessitating surgical revision are mostly limited to joint dislocation after inverse total shoulder replacement (TSR). (Sub)luxation in anatomic TSR can be tolerated provided there is no tendency toward perforation of the skin in a asymptomatic patient. Biological reconstructions are most often indicated for reconstruction of intercalary defects of the humerus, and revision is necessitated most frequently by mechanical complications. Despite multiple surgical revisions, stable reconstructions and limb salvage can usually be achieved in the upper limb.
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Affiliation(s)
- W Guder
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - M Nottrott
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - A Streitbürger
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - J Röder
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - L-E Podleska
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - P Scheidt
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - M Dudda
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - J Hardes
- Klinik für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Essen, Deutschland.
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Hardes J, Guder W, Nottrott M, Podleska L, Täger G, Dudda M, Streitbürger A. [Endoprostheses for stump formation after hip disarticulation]. Orthopade 2019; 48:582-587. [PMID: 30937492 DOI: 10.1007/s00132-019-03721-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hip disarticulation is a psychologically and physically demanding procedure. However, it remains a therapeutical option whenever limb salvage proves impossible due to sarcoma, severe implant-associated infections or trauma. The stump lengthening procedure (SLP) is a surgical technique that allows partial salvage of the thigh through endoprosthetic proximal femur replacement after hip disarticulation, depending on the amount of viable soft tissue coverage. This leads to a more appealing visual appearance, facilitates prosthetic fitting and significantly improves limb function. OBJECTIVES Description of indications for SLP, surgical technique, presentation of clinical and functional outcomes. METHODS Review of applying literature and presentation of outcomes of our own SLP collective. RESULTS The risk of local recurrence does not increase after SLP compared to hip disarticulation. While the majority of patients can be fitted with an exoprosthesis, a walking aid is usually necessary for ambulation. Exoprostheses are usually worn throughout the entire day, and patients manage distances of a mean of 2000 metres, even if reconstruction lengths are less than 10 cm. Patients aged 50 years or older tend to wear their exoprosthesis for shorter periods of daywear and achieve significantly poorer functional scores. Postoperative complications are common at a rate of 52%. Periprosthetic infection (21%) and soft tissue perforation of the implant with subsequent implant-associated infection (14%) were the most severe complications observed. CONCLUSIONS The stump lengthening procedure poses a feasible alternative to classic hip disarticulation in patients with multiple prior operations and/or advanced stages of disease. It leads to satisfactory cosmetic and functional results without jeopardizing local tumor control. Stump perforation presents as the most common complication. Apart from improving the ability to sit down comfortably, both patients treated with a curative and palliative intent manage to ambulate using exoprostheses. With increasing age at the time of operation, walking aids are necessary for ambulation.
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Affiliation(s)
- J Hardes
- Abteilung für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - W Guder
- Abteilung für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - M Nottrott
- Abteilung für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - L Podleska
- Abteilung für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - G Täger
- Abteilung für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - M Dudda
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - A Streitbürger
- Abteilung für Tumororthopädie und Sarkomchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Nottrott M, Streitbürger A, Gosheger G, Guder W, Hauschild G, Hardes J. Intra-articular soft-tissue sarcoma of the knee: Is extra-articular resection and tumor endoprosthetic reconstruction the solution? A retrospective report on eight cases. Orthop Rev (Pavia) 2019; 10:7764. [PMID: 30996836 PMCID: PMC6397995 DOI: 10.4081/or.2019.7764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 01/24/2019] [Indexed: 11/23/2022] Open
Abstract
Intra-articular sarcoma of the knee joint is a very rare condition. Extra-articular resection and reconstruction with a tumor prosthesis is usually performed. This report describes the results with this rare surgical procedure. This retrospective study evaluated the clinical and functional results after extra-articular resection of the knee joint in eight patients with soft-tissue sarcomas of the knee that were reconstructed using a tumor endoprosthesis. Five of the eight patients (62.5%) ultimately had to undergo amputation, mainly due to periprosthetic infection. In addition, two patients experienced periprosthetic fractures. The mean Musculoskeletal Tumor Society score was 18 (range 10-22), as function was impaired due to a weak extensor mechanism. These results suggest that in patients with intraarticular soft-tissue sarcomas, limb salvage procedures with tumor prostheses after extra-articular resection are associated with very high complication rates. In most cases, long-term limb salvage was not possible. When limb salvage is successful, function is also poor due to a weak extensor mechanism in the knee joint. The indication for this procedure should therefore be considered critically.
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Affiliation(s)
- Markus Nottrott
- Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster.,Department of Musculoskeletal Oncology, University Hospital of Essen, University of Duisburg-Essen, Germany
| | - Arne Streitbürger
- Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster.,Department of Musculoskeletal Oncology, University Hospital of Essen, University of Duisburg-Essen, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster
| | - Wiebke Guder
- Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster.,Department of Musculoskeletal Oncology, University Hospital of Essen, University of Duisburg-Essen, Germany
| | - Gregor Hauschild
- Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster
| | - Jendrik Hardes
- Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster.,Department of Musculoskeletal Oncology, University Hospital of Essen, University of Duisburg-Essen, Germany
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Hardes J, Henrichs MP, Hauschild G, Nottrott M, Guder W, Streitbuerger A. Silver-Coated Megaprosthesis of the Proximal Tibia in Patients With Sarcoma. J Arthroplasty 2017; 32:2208-2213. [PMID: 28343825 DOI: 10.1016/j.arth.2017.02.054] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/02/2017] [Accepted: 02/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Proximal tibia arthroplasty is associated with high rates of infection. This study is the largest one that has compared the infection rates with titanium vs silver-coated megaprostheses in patients treated for sarcomas. METHODS The infection rate in 98 patients with sarcoma or giant-cell tumor in the proximal tibia who underwent placement of a titanium (n = 42) or silver-coated (n = 56) megaprosthesis (MUTARS) was assessed, along with the treatments administered for any infection. RESULTS As the primary end point of the study, the rates of infection were 16.7% in the titanium group and 8.9% in the silver group, resulting in 5-year prosthesis survival rates of 90% in the silver and 84% in the titanium group. Whereas in the titanium group 37.5% of patients ultimately had to undergo amputation in the present study, these mutilating surgical procedures were only necessary in the silver group in one patient (14.3%). CONCLUSION The use of silver-coated prosthesis reduced the infection rate in a relatively large and homogeneous group of patients. In addition, less-aggressive treatment of infection was possible in the group with silver-coated prosthesis.
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Affiliation(s)
- Jendrik Hardes
- Department of Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
| | - Marcel P Henrichs
- Department of Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
| | - Gregor Hauschild
- Department of Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
| | - Markus Nottrott
- Department of Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
| | - Wiebke Guder
- Department of Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
| | - Arne Streitbuerger
- Department of Orthopaedics and Tumour Orthopaedics, Münster University Hospital, Münster, Germany
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Schmidt-Braekling T, Streitbuerger A, Gosheger G, Boettner F, Nottrott M, Ahrens H, Dieckmann R, Guder W, Andreou D, Hauschild G, Moellenbeck B, Waldstein W, Hardes J. Silver-coated megaprostheses: review of the literature. Eur J Orthop Surg Traumatol 2017; 27:483-489. [PMID: 28265758 DOI: 10.1007/s00590-017-1933-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/26/2017] [Indexed: 01/06/2023]
Abstract
Periprosthetic infection remains one of the most serious complications following megaendoprostheses. Despite a large number of preventive measures that have been introduced in recent years, it has not been possible to further reduce the rate of periprosthetic infection. With regard to metallic modification of implants, silver in particular has been regarded as highly promising, since silver particles combine a high degree of antimicrobial activity with a low level of human toxicity. This review provides an overview of the history of the use of silver as an antimicrobial agent, its mechanism of action, and its clinical application in the field of megaendoprosthetics. The benefits of silver-coated prostheses could not be confirmed until now. However, a large number of retrospective studies suggest that the rate of periprosthetic infections could be reduced by using silver-coated megaprostheses.
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Affiliation(s)
- Tom Schmidt-Braekling
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany.
| | - Arne Streitbuerger
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA
| | - Markus Nottrott
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Helmut Ahrens
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Ralf Dieckmann
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Wiebke Guder
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Dimosthenis Andreou
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Gregor Hauschild
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Burkhard Moellenbeck
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Wenzel Waldstein
- Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Jendrik Hardes
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
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Kurz A, Riemenschneider M, Buch K, Willoch F, Bartenstein P, Müller U, Guder W. Tau protein in cerebrospinal fluid is significantly increased at the earliest clinical stage of Alzheimer disease. Alzheimer Dis Assoc Disord 1998; 12:372-7. [PMID: 9876968 DOI: 10.1097/00002093-199812000-00020] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The concentration of tau protein in cerebrospinal fluid (CSF) was determined in 40 patients with clinically diagnosed probable Alzheimer disease (AD) and in 36 cognitively healthy controls. A significant increase of CSF tau was found in the AD patients, even in 19 subjects with very mild dementia as defined by a Mini-Mental State Examination score of 25 and above. Using a cutoff value of 260 pg/mL the sensitivity of elevated tau was 0.89, the specificity was 0.97, and the proportion of correctly allocated cases was 95%. In the AD groups there were no significant associations between CSF tau level and age, age at onset, duration of illness, apolipoprotein E genotype, severity of cognitive impairment, or deficit in regional cerebral blood flow as measured using 99Tm-ethyl cystein dimer single photon emission computed tomography. The findings demonstrate that CSF tau is significantly increased at the earliest clinical stage of AD and shows only minimal overlap with age-matched cognitively healthy controls. This finding suggests that CSF tau could be a biological marker of AD even before dementia has developed.
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Affiliation(s)
- A Kurz
- Department of Psychiatry, Technische Universität, München, Germany
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Guder W, Buttner J. [Clinical chemistry in laboratory medicine in Europe. The past, present, and future]. Klin Lab Diagn 1998:35-40. [PMID: 9865004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Guder W, Kruse-Jarres JD. Is glucose a reliable index of carbohydrate metabolism? Report on the joint workshop conference "Glucose" of the German Society for Clinical Chemistry and the German Diabetes Society held on May 15-16, 1981 in Stuttgart, Germany. J Clin Chem Clin Biochem 1982; 20:135-40. [PMID: 7077227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The determination of glucose concentration is the most frequently used clinical laboratory test. It was the current vehemence in discussions about the judgement criteria for the diagnosis and monitoring of diabetes that motivated this discussion of pathobiochemical and analytical aspects in a circle of 38 experts. The composition of the working group made it possible to compare the needs of clinical diabetologists and diabetics with the analytical possibilities. Pathobiochemistry, sampling problems, diabetic self control, analytical methods and their standardisation, glucose monitoring, glucose sensors and glycosylated proteins were the topics of this glucose workshop.
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Huber J, Guder W, Müller OA, Latzin S, Ganser H, Hamprecht B. Influence of hypophysectomy, thyroid hormone and insulin on the activity of 3-hydroxy-3-methylglutaryl-coenzyme A reductase in rat liver. Hoppe Seylers Z Physiol Chem 1974; 355:669-74. [PMID: 4435746 DOI: 10.1515/bchm2.1974.355.1.669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Huber J, Guder W, Müller OA, Latzin S, Ganser H, Hamprecht B. Influence of hypophysectomy and thyroid hormone on the activity of 3-hydroxy-3-methylglutaryl-coenzyme A-reductase in rat liver. Z Klin Chem Klin Biochem 1974; 12:269. [PMID: 4440196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Huber J, Guder W, Latzin S, Hamprecht B. The influence of insulin and glucagon on hydroxymethylglutaryl coenzyme A reductase activity in rat liver. Hoppe Seylers Z Physiol Chem 1973; 354:795-8. [PMID: 4803511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Guder W, Wieland O. [Lactate metabolism of isolated kidney tubules and interconversion of pyruvate dehydrogenase (PHD)]. Hoppe Seylers Z Physiol Chem 1972; 353:1520-1. [PMID: 4346458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Huber J, Hamprecht B, Müller OA, Guder W. [Diurnal rhythm of hydroxymethylglutaryl-CoA reductase in rat liver. II. Rhythm of adrenalectomized animals]. Hoppe Seylers Z Physiol Chem 1972; 353:313-7. [PMID: 5028198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Guder W, Wiesner W, Stukowski B, Wieland O. Metabolism of isolated kidney tubules. Oxygen consumption, gluconeogenesis and the effect of cyclic nucleotides in tubules from starved rats. Hoppe Seylers Z Physiol Chem 1971; 352:1319-28. [PMID: 4331491 DOI: 10.1515/bchm2.1971.352.2.1319] [Citation(s) in RCA: 88] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Guder W, Hepp KD, Wieland O. The catabolic action of glucagon in rat liver. The influence of age, nutritional state and adrenal function on the effect of glucagon on lysosomal N-acetyl-beta, D-glucosaminidase. Biochim Biophys Acta 1970; 222:593-605. [PMID: 4322197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Affiliation(s)
- W Guder
- Klinisch Chemisches Institut, Krankenhaus München-Schwabing and Forschergruppe Diabetes, München 23, 1, Kölner Platz, Germany
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Guder W, Wieland O. The effect of cyclic nucleotides on glucose synthesis in isolated rat kidney tubules. Hoppe Seylers Z Physiol Chem 1970; 351:291-2. [PMID: 4316051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Weiss L, Guder W, Wieland O. [Influence of phosphatides and taurocholate on rat liver acid triglyceride lipase]. Hoppe Seylers Z Physiol Chem 1969; 350:1179. [PMID: 5352348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Guder W, Weiss L, Wieland O. Triglyceride breakdown in rat liver. The demonstration of three different lipases. Biochim Biophys Acta 1969; 187:173-85. [PMID: 5822407 DOI: 10.1016/0005-2760(69)90025-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Affiliation(s)
- W Guder
- Klinisch-chemisches Institut und Forschergruppe Diabetes, Städt. Krankenhaus München-Schwabing, München 23, 1, Kölner Platz, Germany
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Guder W, Nolte I, Wieland O. The influence of thyroid hormones on beta-hydroxy-beta-methylglutaryl-coenzyme A reductase of rat liver. Eur J Biochem 1968; 4:273-8. [PMID: 5655502 DOI: 10.1111/j.1432-1033.1968.tb00204.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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