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Zusammenfassung

Aims. This study reports outcome, functional results and quality of life of 45 elderly patients with age over 70 after surgery for primary malignant bone and soft tissue tumours. Methods. There were 24 primary malignant bone tumours and 21 soft tissue sarcomas. The most frequent diagnoses were: chondrosarcoma, malignant fibrous histiocytoma and liposarcoma. Local tumour resection with and without osteosynthesis, endoprostheses, and amputations had been performed for surgery. The patients were prospectively followed in a tumour register. Results. Complication and revision rate, functional outcome using the Musculoskeletal Tumor Society score, 5-year survival rate, median survival time and quality of life according to the Life Satisfaction Index A and the global health and quality-of-life scale of the QLQ-C30 revealed results that are only slightly inferior to those reported in younger tumour patients. Conclusions. The results of this study generally justify even extensive tumour surgery in the elderly patient over 70 although outcomes are not quite as good as those reported for younger adults. However, especially in the old patient indications like general condition and comorbidity should be given due consideration before any decision is made on whether surgery should be performed and if so what surgical technique should be applied.

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Zusammenfassung.: Die retrospektive Analyse von 30 Patienten mit einer pathologischen Fraktur aus einem Gesamtkollektiv von 336 Patienten mit primär malignen Knochentumoren soll klären, welchen Einfluß das Auftreten einer pathologischen Fraktur und die Form der chirurgischen Therapie auf die Überlebenswahrscheinlichkeit haben. Bei 25 von 30 Patienten führte die Fraktur zur Diagnose des Tumorleidens. Pathologische Frakturen traten gehäuft bei malignen fibrösen Histiocytomen des Knochens und bei Tumoren im Stadium IIb und III auf. 26 von 30 Patienten wurden chirurgisch therapiert (12 ablative Verfahren, 14 extremitätenerhaltende Verfahren). Das Sterberisiko von Patienten mit pathologischer Fraktur war gegenüber den Patienten ohne pathologische Fraktur mehr als verdoppelt (p = 0,0062). Bei Einhaltung adäquater Resektionsgrenzen ist die Überlebenswahrscheinlichkeit von Patienten mit einer pathologischen Fraktur durch extremitätenerhaltende Rekonstruktionsverfahren nicht beeinflußt.

We studied the effects of irradiation on the reintegration of autologous osteoarticular grafts over a period of 24 weeks in a canine model. In 16 foxhounds the medial femoral condyle was resected, irradiated and immediately replanted. In the control group resection and replantation were performed without irradiation. Reintegration was assessed by macroscopic analysis, histology, radiography and gait analysis.Reintegration was equal at 12 weeks, but significantly inferior in the irradiated group after 24 weeks with delayed bone remodelling. The articular cartilage showed modest degeneration. Conventional radiography and histology showed corresponding changes. Limb function was adequate but the gait was inferior in the treated group.

We report our results using three different threaded acetabular components (Mecring A, Mecring B and Weill) in 715 hips with a follow-up of between one and ten years (median: 99.1, 56.5, 38.3 months, respectively). All cups were implanted with one type of cementless stem.The clinical results were good or acceptable in about 70% of the hips, but signs of loosening with radiolucency and/or migration were found in 10.1%. Radiological evidence of loosening did not correlate significantly with the clinical outcome. Pain was not a reliable indicator of loosening and its absence sometimes allowed severe osteolysis to develop. Twenty-five hips were revised (3.5%) for aseptic loosening of the acetabular component. Kaplan-Meier estimates of the cumulative rate of failure showed a rapid increase five years after the initial operation, but no significant correlation with gender, age or weight.The high rate of failure indicates that further use of these acetabular components cannot be recommended. Annual radiographs are required to assess osteolysis even if the patients are free from pain.

We investigated retrospectively 132 cases of open wedge high tibial osteotomy using an external fixation device, concentrating on the rate of neurological complications. One group of patients underwent surgery according to the conventional technique (n=89). The rate of transient neurological complications was 15.7%; 7 months after surgery the rate of persistent deficits was 12.4%. For the second group (n=43) a modified surgical technique was used that lowered the complication rate significantly (transient deficits 14%, persistent deficits 4.7%). In the modified technique the osteotomy is not performed in the conventional way using an oscillating saw but through consecutive drill holes of increasing diameter followed by osteoclasis. The lower complication rate in the second group is mainly due to the less extensive approach that leads to a smaller number of postoperative tibialis anterior syndromes (type B lesion). No differences were found with type C lesions (extension deficit of D1). No complete peroneal nerve palsy (type A) occurred in either group. We conclude that the reduction of neurological complications in group 2 is related to the less extensive approach of the proposed technique.

The possibilities of using approximate self-consistent field energy functionals to reduce computation required in calculating photoelectron transition energies is examined. Numerical results for the H2O molecule indicate that this is possible without unacceptable deterioration in accuracy of results in favourable cases.

Among the rare soft tissue sarcomas the leiomyosarcoma of the veins is only to be found in very few cases. On the basis of a case report the procedure of surgical treatment concerning this tumour is described; usually, in addition to the resection of the compartment a vascular reconstruction is required.

In a prospective study radiographs and magnetic resonance images of 75 patients with calcifying tendinitis of the rotator cuff were analyzed. The aim was to evaluate any relation between calcifying tendinitis and subacromial impingement. A total of 83% of the calcifications were located in the supraspinatus or the adjoining part of the subscapularis tendon. On T1-weighted images they could be demonstrated with high accuracy as areas of decreased signal intensity. A magnetic resonance imaging categorization of the calcium deposits was carried out by means of a differentiation of form, outline, and density. A partial rotator cuff tear was found in one shoulder; in 11% variable aspects of degenerative alteration of the affected tendon were seen. By analysis of the radiographic outlet view 16% of the cases had a type III acromion. In conclusion, little correlation exists between calcifying tendinitis and additional findings associated with subacromial impingement.

In a prospective longitudinal study over 2 years and a separate cross-sectional study more than 5 years after operation, we analyzed periprosthetic bone mineral density (BMD) after cementless total hip arthroplasty (THA) (press-fit cementless Spotorno stem, Mecron threaded acetabular cup) by dual-energy X-ray absorptiometry (DEXA). BMD was analyzed in a longitudinal prospective study (n = 53 patients: 29 women, 24 men) and in a separate cross-sectional study (n = 23 patients: 13 women, 10 men) with good clinical outcome (Merle d’ Aubigne score > 12). Regions of interest were defined according to Gruen (ROI 1–7) and as netto average ROI (NETAVG I) for the periprosthetic femur, and according to De Lee and Charnley (ROI I-III) and as NETAVG II for the periprosthetic acetabulum. BMD during follow-up was compared with immediate postoperative values of the affected limb. Mean precision error (CV%) was 2.6 ± 0.5% for ROI 1–7 and 1.3 ± 0.9% for ROI I–III. BMD significantly decreased in the periprosthetic femur and acetabulum during the first 3 months after operation. At the femur, BMD (NETAVG I) for women and men, respectively, was 92.4% and 87.5% at 6 months, then 89.4% and 96.2% at 2 years. ROIs around the proximal stem showed the lowest absolute values and decreased most during follow-up (to 79.9% ROI 1 and 68.2% ROI 7, respectively). Mineralization around the cup (NETAVG II), respectively, amounted to 81.1%, 82.6% at 6 months, then 80.1% and 93.8% at 2 years. The medially placed ROI II demineralized most (respectively, 72.1% and 76.7%). More than 5 years after THA, BMD in the femur showed little change, but decreased significantly to 76.4% and 79.1%, respectively, around the cup (NETAVG II). DEXA is a useful method for analyzing changes of mineralization around cup and stem of cementless THA. The results reflect the different stress on the periprosthetic bone after implantation of THA in defined ROIs, supporting earlier reported good clinical results of the Spotorno stem and increased loosening rate of threaded acetabular cups after 5 years.

It has been proposed that the nucleotide sequences of the 3' terminal extracistronic regions of phage RNA plus and minus strands have been strictly conserved during evolution because they are stringently required for recognition by the viral replicase. We have devised a method to generate point mutations at selected sites in the genome of phage Qbeta. The in vitro synthesis of Qbeta RAN with G leads to A transition in the 16th position from the 3' end, i.e., in the terminal extracistronic region of the genome, is outlined. When a mixture of about 60% wild-type and 40% mutant RNA was repeatedly replicated, the mutant RNA was enriched to 80%, showing that at least this point mutation in the terminal sequence of Qbeta RNA does not impair its in vitro replication, but in fact slightly accelerates it.

Summary. Bone mineralisation during and after limb lengthening procedures on the femur or tibia using unilateral fixators has been monitored quantitatively using dual energy X-ray absorptiometry (DEXA). We measured the bone mineral density (BMD) prospectively in the newly formed callus, in the bone adjacent to the callus and in the proximal femur. In twenty-one patients we showed a typical course with a peak value at 4 – 6 weeks after beginning distraction and a minimum value at maximum distraction. In the consolidation period the BMD in the distraction gap increased until the fixator was removed. The BMD in the regenerated bone increased faster in the regions of interest (ROI) opposite the fixator compared to those near it. Dynamisation caused more homogeneous regeneration equalising V: BMD : in the different ROIs. The BMD in the proximal femur of the leg which was operated on decreased to 67% and in the opposite leg to 87% of the preoperative value. DEXA provides a precise and quantitative assessment of callus and bone mineralisation during limb lengthening and helps in understanding what is happening during these procedures.

Little is known about the influence of high-performance training on the bone quality of the lumbar spine, in particular, the effects on bone mineral density (BMD) in athletes with high weight-bearing demands on the spine. Measurements were therefore performed in internationally top-ranked high-performance athletes of different disciplines (weight lifters, boxers, and endurance-cyclists). The measurements were carried out by dual-energy X-ray absorptiometry, and the results compared with the measurements of 21 age-matched male controls. The BMD of the high-performance weight lifters was greater than that of the controls by 24% (0.252 g/cm2) on the AP view and by 23% (0.200 g/cm2) on the lateral view (P<0.01), while difference in BMD between the boxers and the controls was+17% (0.174 g/cm2) on the AP view and +19% (0.174 g/cm2) on the lateral view. The BMD of the lumbar spine in all endurance cyclists was lower than that in the controls (AP view-10%, 0.105 g/cm2; lateral view-8%, 0.067 g/cm2; P>0.05). The results show that training program stressing axial loads of the skeleton may lead to a significant increase of BMD in the lumbar spine of young individuals. Other authors' findings that the BMD of endurance athletes may decrease are confirmed. Nevertheless the 10% BMD loss of cyclists was surprisingly high.

The binaural masking level difference (MLD) was measured at multiple masking levels (i.e. 500Hz narrow band noise presented at 50-100dB overall SPL) in normal hearing subjects and clinical subjects with varying types and degrees of hearing loss. MLD versus noise level (MLD-NL) functions then were derived for each subject. Some growth in the MLD-NL was seen in nearly all cases of hearing loss up to 70 dB in the poorer ear. These findings suggest that the MLD-NL function may provide the basis for extending the diagnostic usefulness of the MLD test in cases of substantive hearing loss.

In this paper we obtain the necessary and sufficient conditions on permutations of numerical series which transformed any B-summable series into an A-summable series, where A and B are matrices satisfying certain conditions.

High tibial wedge osteotomies are often followed by transient neurological complications. From a retrospective study of 132 patients it appears that the incidence of this troublesome complication can be reduced after osteotomy with external fixation by using a technique of making consecutive drill holes of increasing diameter followed by osteoclasis. This reduction of neurological complications was most marked when a less extensive surgical approach was used.

Eleven articles reporting 39 patients with the combination of progressive scoliosis and familial congenital gaze palsy have now been published. This disorder appears to be caused by a malfunction of the normal equilibrial control mechanism related to the brainstem or the central nervous system. The scoliosis progresses when the children begin to walk. Even when they are treated with physiotherapy or brace, they often require early operation. We consider that progressive juvenile or infant scoliosis associated with familiar congenital horizontal gaze palsy constitutes a clinical entity. We report two sisters with congenital gaze palsy, in one of whom scoliosis of at least 70° (Cobb) developed, and review and analyze all cases published until now.

Using a common technique [ 1, 2] for approximating distributions [generalized functions], we are able to use standard Monte Carlo methods to compute QFT quantities in Minkowski spacetime, under phase transitions, or when dealing with coalescing stationary points. [Copyright &y& Elsevier]

Two new approaches to numerical QFT are presented. [Copyright &y& Elsevier]