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AIM The opportunities of autologous dermal and epidermal grafting as starting point for non-invasive reconstruction of extensive soft tissue defects will be demonstrated and discussed. METHODS Skin biopsies for cell cultivation were taken from patients with extensive acute soft tissue defects of different origin. Cultured autologous fibroblasts grown on three dimensional biocompatible scaffolds made up of benzyl ester of hyaluronan were transplanted as "neo-dermis" on debrided and conditioned wound sites. After incorporation of the dermal equivalents grafting of subconfluent proliferative keratinocytes on hyaluronan based laser perforated membranes was performed. Ten days later a 0.2 mm thin, 1 : 6 meshed autograft to create definite biomechanical stability was overlaid. RESULTS Grafting of in vitro cultured autologous fibroblasts revealed a good vascularized dermal tissue substitute. After keratinocyte-transfer formation of thin epithelium was visible. Final closure of the defects with aesthetic and normo-elastic tissue properties was achieved after thin mesh-grafting. CONCLUSIONS Preliminary results seem to be very promising. Clinical follow-up as well as histological and immunohistochemical outcome in the treatment of five extensive soft-tissue defects are discussed. As in all fields of tissue engineering, long-tem studies and cost-benefit analyses are required.

Pregnancy-associated osteoporosis is an uncommon condition characterized by the occurrence of painful fractures during late pregnancy or lactation. To date the pathophysiology of this entity of bone disorder is still uncertain, and its therapeutical management is poorly defined. We report two clinical cases: a 10-years follow-up with pain medication and intermittent antiresorptive therapy courses, subsequent traumatic vertebral fracture and actually fracture of scaphoid after inadequate trauma. Beside this long-term course a young female patient with pregnancy-associated osteoporosis and painful lumbar and also thoracic vertebral fractures is described. She was treated with an osteoanabolic therapy, at the timepoint of first follow-up at 6 months of treatment a solid increase of bone mineral density and sustained pain reduction was observed.

Hyperphosphataemia, calcitriol deficency and secondary hyperparathyroidism (sHPT) are common complications in end-stage chronic kidney diseases (CKD). Fibroblast Growth Factor 23 (FGF-23) is a phosphaturic peptide, secreted by the osteoblast precursors, that also inhibits renal 1-alpha-hydroxylase activitiy and tubular phosphate reabsorption by the inhibition of sodium-dependant renal phosphate transport (Na-Pi-IIa). Consequences are a decreaese of serum 1,25 dihydroxyvitamin D3 and phosphaturia. Therefore, FGF-23 plays a role in hyperphosphataemia in association with CKD and may be involved in the pathogenesis of sHPT. Increased FGF-23 may contribute to maintaining a normal serum phoshpate level in face of a processing CKD, but if the creatinine clearance is reduced to lower than 30 ml/min the capacity of this regulative mechanism ends and hyperphosphataemia results. In our investigation of end-stage renal diseases markedly increased serum FGF-23, associated with hyperphosphataemia, phosphaturia and decreased serum calcitriol and sHPT, were found. Furthermore preanalytical testing for the stability of FGF-23 was performed by comparing samples which were stored at -20 degrees C with samples that have been stored for 6 days at +4 degrees C. The simultaneous investigation of serum and EDTA plasma FGF-23 certifies the advantage of EDTA plasma in subjects with an intact renal function.