[Secondary Angiosarcoma of the Breast after Breast-conserving Therapy]. / Das sekundäre Angiosarkom der Brust nach brusterhaltender Therapie.

BACKGROUND: Mammography for the detection of early stage breast cancer is widely established. Breast-conserving therapy followed by radiation therapy is the most common therapy for early stage breast cancer. Due to the increasing use of radiation therapy in breast cancer, secondary neoplasia are induced. The most common secondary neoplasia of the breast is the angiosarcoma. It occurs 4-7 years after radiation therapy. Genetic predisposition and a transformation of endothelial cells by radiation therapy are known to lead to angiosarcoma. OBJECTIVE: The present paper outlines a concept for treatment on the basis of the current literature and the experience of the authors. RESULTS AND CONCLUSION: Radical surgical resection of the tumour with a sufficient margin of safety is the treatment of choice for angiosarcoma. Tumour infiltration of the chest wall and other local structures are challenges for the surgeon performing a radical tumour resection. The replacement of the tissue is also demanding for the surgeon. After radiation therapy the reconstructive options are limited. Individual factors such as age, quality of local vessels and the patients demand for breast reconstruction should be considered. Although R0 resection is performed, the 5-year survival rates are 20-30%.

[Complication of self-injection with petroleum jelly for penis augmentation]. / Komplikation durch Selbstinjektion mit Vaseline zur Penisaugmentation.

An increasing number of complications after penis enlargement procedures, sometimes self-performed, are being observed in Germany and in the other countries. This report presents a case of a 43-year-old patient who presented with multiple fistulas, paraffinomas and bacterial superinfection after having injected petroleum jelly into his penis. In order to remove the foreign bodies as well as the infected and necrotic tissue the complete epithelium had to be radically excised. After further local and surgical wound treatment penis reconstruction with a full thickness skin graft was performed which later led to a functional and aesthetical complete restoration to the original condition.

Differentiation of progressive supranuclear palsy: clinical, imaging and laboratory tools.

Progressive supranuclear palsy (PSP) is the most common atypical parkinsonian syndrome comprising two main clinical subtypes: Richardson's syndrome (RS), characterized by prominent postural instability, supranuclear vertical gaze palsy and frontal dysfunction; and PSP-parkinsonism (PSP-P) which is characterized by an asymmetric onset, tremor and moderate initial therapeutic response to levodopa. The early clinical features of PSP-P are often difficult to discern from idiopathic Parkinson's disease (PD), and other atypical parkinsonian disorders, including multiple system atrophy (MSA) and corticobasal syndrome (CBS). In addition, rare PSP subtypes may be overlooked or misdiagnosed if there are atypical features present. The differentiation between atypical parkinsonian disorders and PD is important because the prognoses are different, and there are different responses to therapy. Structural and functional imaging, although currently of limited diagnostic value for individual use in early disease, may contribute valuable information in the differential diagnosis of PSP. A growing body of evidence shows the importance of CSF biomarkers in distinguishing between atypical parkinsonian disorders particularly early in their course when disease-modifying therapies are becoming available. However, specific diagnostic CSF biomarkers have yet to be identified. In the absence of reliable disease-specific markers, we provide an update of the recent literature on the assessment of clinical symptoms, pathology, neuroimaging and biofluid markers that might help to distinguish between these overlapping conditions early in the course of the disease.

[Individual and function-dependent therapeutic concept for the ruptured anterior cruciate ligament]. / Individuelles und funktionsabhängiges Therapiekonzept nach vorderer Kreuzbandruptur.

The knee joint is a ligament guided and muscular stabilized joint. Therefore the rupture of the anterior cruciate ligament (ACL) causes a functional deficit with change of the knee kinematics and the dynamic muscle stabilization. The muscular dysfunction can be the result of inadequate muscle strength, a neuro-muscular control defizit, a propriozeptive dysfunction or often the combination of these causes. Due to the complex anatomy of the ACL an exact, patient specific operative anatomical reconstruction is not possible. Therefore we suggest primarily a conservative therapeutic approach. If this approach fails the reconstruction will be performed after the first rehabilitation phase. Independently from the conservative or surgical approach, the rehabilitation program consists of four function-based phases and the overall therapy goal is to achieve the same or even higher activity level than before the lesion.

[Prospective study on injuries of the German national ice hockey teams in more than 1000 games]. / Prospektive Studie über Verletzungsmuster der Deutschen Eishockeynationalmannschaften bei über 1000 Länderspielen.

Due to the fast and physical nature of the game, prevention of injuries is an important issue in ice hockey. The injuries of the German male senior and junior (U16, U17, U18, U19, U20) national ice hockey teams were documented and analyzed in 1006 games between 1986 and 2006. This unique long observation period over 20 years, as well as the standardized protocol of documentation provides reliable data concerning injury pattern in German international ice hockey. Overall 277 injuries were recorded. Comparing the first and the last ten years of observation, the number did not decline over the time, despite various national and international efforts of injury prevention. The majority of the injuries, almost 60%, were caused by body contact with increasing tendency. Remarkably, the injuries with no body or puck/stick contact more than doubled in the last ten years compared to the first ten years of observation. Most injuries happened to the extremities with decreasing tendency to lower body and increasing tendency to upper body injuries. The number of head injuries did not change significantly. More injuries occurred in the second and third period compared to the first period of the game. The data of this study indicate that many injuries might be due to insufficient physical condition with consecutive lack of concentration and coordination. Players do not seem to meet the increasing technical and athletic requirements of international ice-hockey. The increasing speed and physical energy in international ice-hockey make the game unique and fascinating. Therefore, the aim must be to decrease the number and above all the severity of injuries by further development and adjustment of the player's equipment. Also, a better cooperation of players, coaches, sports medicine and referees seems to be necessary for injury prevention in the future.

The mobilisation of mononuclear cells and endothelial progenitor cells after burn injury in a porcine model.

BACKGROUND: Mononuclear blood cells (MNCs) consist of heterogeneous cell populations, for example, CD34+ cells and endothelial progenitor cells (EPCs). EPCs are involved in vasculogenesis, but little is known about their role during burn trauma. AIM: This study investigates the role of MNCs and their subpopulations during and after burn injury in an experimental porcine setting. METHODS: Eighteen 8-week-old German land pigs were scalded by immersion in 70 degrees C hot water for 3 min, resulting in a 30% total body surface area (TBSA) full-thickness burn. Vascular endothelial growth factor (VEGF) serum concentrations and MNC, EPC and CD34+ cell counts were measured at eight different time points up to 48 h following trauma. RESULTS: The experimental porcine setting made it possible to determine the cell counts of MNCs, EPCs and CD34+ cells directly during burn trauma, which has not been described before. The data revealed a fulminant drop in MNC and EPC during burn trauma, whereas the CD34+ cell fraction rose. Besides significant changes in the VEGF serum concentration, a correlation between VEGF and EPC was also observed. CONCLUSION: The results show that MNCs and their subpopulations are significantly affected by burn trauma and underpin their potential diagnostic and therapeutic importance during and after burn injury.

Tissue substitutes with improved angiogenic capabilities: an in vitro investigation with endothelial cells and endothelial progenitor cells.

The use of implantable biomaterials, such as artificial skin substitutes used for dermal defects, remains limited by the low angiogenic potential of these products. The rapid in vivo degradation of growth factors contributes to the limiting of angiogenesis in biomaterials. Here, we report on collagen sponges in which vascular endothelial growth factor (VEGF) was immobilized through physical binding to heparin, covalently incorporated in the matrix via cross-linking with 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) and N-hydroxysuccinimide. The in vitro release of VEGF over time and endothelial cell proliferation were investigated in matrices modified at varying heparin to EDC ratios either nonloaded or loaded with VEGF. ELISA demonstrated a significantly slower in vitro release of VEGF over a period of 5 days from heparinized matrices as compared to their unmodified and cross-linked counterparts. The effects of these modifications on the proliferation of endothelial cells and endothelial progenitor cells were evaluated after 1, 3 and 5 days either according to the bromodeoxyuridine assay or total cell counting with a Neubauer chamber. The endothelial and endothelial progenitor cells cultured in contact with heparinized matrices loaded with VEGF revealed both the highest rate of DNA synthesis and the highest total cell count. Furthermore, these results show that the cross-linking of collagen matrices - both in the presence and absence of heparin - leads to increases of the proliferative activities. We can assume that these changes lead to matrices with increased angiogenic capabilities.

Bioelectric impedance analysis and quality of life after body-contouring procedures in plastic surgery.

BACKGROUND: This study dealt with the assessment of two body-contouring patient groups, the first having undergone abdominoplasty and the second liposuction. The focus of inquiry was the change in body mass index (BMI) values and the correlation of these with health-related quality of life (HRQoL). METHODS: Fat and BMI values for 98 consecutive patients were determined 1 h preoperatively, and 1 day, 3 weeks, and 3, 6, and 12 months postoperatively. Operative results and quality of life were evaluated using an individual patient questionnaire and the 'Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being' (FACIT-SP), which were completed preoperatively and 12 months postoperatively. RESULTS: The liposuction group showed a significant reduction in fat and BMI values, and liposuction as well as abdominoplasty patients exhibited an increase in HRQoL 1 year after surgery (P<0.001). The liposuction patients showed an average decrease of 1.98 kg body fat and a decrease in BMI values of 0.94 kg/m(2) 1 year following surgery. The abdominoplasty patients showed an average decrease of 2.97 kg in body fat, and a BMI reduction of 0.11 kg/m(2) after 12 months. The FACIT-questionnaire score increased from 91.57 preoperatively to 136.16 points postoperatively for liposuction patients, and from 89.12 to 132.43 points for the abdominoplasty patients. On the individual questionnaire, liposuction patients improved from 14.83 to 24.77 points, whereas abdominoplasty patients showed an increase from 16.84 to 25.21 points. CONCLUSIONS: These findings indicate an overall improvement in HRQoL of the abdominoplasty as well as the liposuction patients, in the latter group accompanied by long-term success in reduction of fat and BMI values.

Retrospective analysis of tissue expansion in reconstructive burn surgery: evaluation of complication rates.

Tissue expansion is a widespread and accepted concept in reconstructive surgery, but is also afflicted with a variety of complications. In burn patients, this technique allows large areas of burn scar to be replaced by tissue of similar texture and colour to the defect. We retrospectively reviewed our results with tissue expanders in 57 burn patients over a period of 8 years including 102 expanders. Statistical analyses revealed a significant influence of the anatomical region (p=0.0156; Chi-square=15.6811) and of the expander volume (p=0.0417; Chi-square=18.8918) on the failure rate outcome. Factors such as age, gender, number of expanders per patient and shape of expander showed no statistical correlation in relation to the failure rate (p-values >0.05). Furthermore, we present a short review of the recent literature of complications after tissue expansion. The presented study may help to draw attention on different aspects in tissue expansion and critically focus on each step of the tissue expansion procedure from implantation over inflation to explantation.

[Merkel cell carcinoma and immunosuppression: report of three cases and review of therapeutic options]. / Das Merkel-Zell-Karzinom und immunsuppression: drei fallberichte und uberblick der therapeutischen optionen.

Merkel cell carcinoma (MCC) is a cutaneous, neuroendocrine tumour of high malignancy that is described as a firm, purple tumour localised in the dermal layer. Due to its high progression rate, the 5-year survival rate is quoted as between 30 and 74 %. The course of disease is characterised by high relapse rate (30 - 77 %) and lymph node metastases (ca. 50 %). Therapy of MCC is based on a radical surgical excision combined with sentinel lymph node biopsy (stadium I), lymph node dissection (stadium II) and postoperative radiotherapy. We report three cases of MCC under immunosuppression and present therapeutic options of MCC in overview.

Beneficial effect of corticosteroids in catecholamine-dependent septic burn patients.

Recent studies indicated the benefit of hydrocortisone in septic patients based on the significant reduction of catecholamines and improved outcome in common intensive care patients. The treatment of intensive care burn patients with corticosteroids was discussed with great caution due to the especially compromised immune status of severely burned patients. The purpose of this study was to investigate the influence of corticosteroids in burn patients during septic shock. In our burn unit, we started with the administration of cortisol in 2001. In this retrospective study, 10 severely burned patients received, > or = 24h after norepinephrine dependency, hydrocortisone infusions of 200 mg/24 h. The course of norepinephrine dose, hemodynamic measurements (Swan-Ganz-Catheter) and daily Sequential Organ Failure Assessment (SOFA-Score) were analyzed and compared to nine (catecholamine-dependent) burn patients without cortisol therapy. Statistical analysis by means of Fisher's Exact Test revealed beneficial effects (morbidity and mortality) of low dose cortisol therapy compared to control patients. However, the results of this study must be interpreted with caution because of its limited number of patients and its retrospective character. Further randomized prospective controlled studies are necessary to determine the efficacy and safety of cortisol therapy in burn patients.

[Necrotizing fasciitis following therapeutic injection in a shoulder joint]. / Nekrotisierende Fasziitis nach Injektionstherapie im Schultergelenk.

Necrotizing fasciitis is an inflammatory, rapidly progressive soft tissue infection usually caused by Streptococcus pyogenes or by a combination of aerobic and anaerobic microorganisms. Here we report the case of a patient who developed necrotizing fasciitis near the site of therapeutic injections. An orthopaedic surgeon in private practice had given the 74-year-old patient, who suffered from left shoulder pain, cortisone injections in his left shoulder joint. During the course of this therapy, the patient developed necrotizing fasciitis. Despite radical surgical debridement of the patient's back, left thorax and amputation of his left arm, the patient expired 15 h after arriving at our department. In cases such as these, patient survival depends upon an early diagnosis followed by immediate radical surgical intervention including complete opening of fascial compartments and excision of necrotic tissues.

[Varicella associated necrotizing fasciitis in a child]. / Varizellenassoziierte nekrotisierende Fasziitis beim Kind.

We present a rare case of necrotizing fasciitis in an 5-year-old infant with preexisting varicella infection. Initially, the patient showed acute pain and swelling of the left thorax with high inflammatory parameters and varicella-specific skin affections. MRT presented diffuse soft tissue swelling of the left chest consistent with necrotizing fasciitis. After aggressive surgical debridement of necrotic tissue and extirpation of axillary lymph nodes, the clinical course improved under appropriate parenteral antimicrobial therapy using penicillin and clindamycin. In conclusion, necrotizing fasciitis should be suspected in any child with a history of varicella infection and increasing complaints of pain and swelling in an extremity or other body area associated with increasing fever, erythema, lethargy, and irritability. Shock, multiorgan failure, and death will ensue if the diagnosis is not promptly recognized.

[A rare case of cannabis arteritis]. / Ein seltener Fall von Cannabis-Arteritis.

A 24-year old woman, heavy cannabis smoker with progressive Raynauld's phenomenon and digital necrosis is presented. Systemic sclerosis and other connective tissue disorders as well as arteriosclerosis and arterial emboli were excluded with appropriate laboratory examinations. Arteriography revealed multiple forearm, palmar and digital occlusions with corkscrew-shaped vessels. Based on these characteristic arteriography and clinical findings, the diagnosis of cannabis-arteritis was finally retained. With careful necrectomy, conservative wound dressings and secondary prostacyclin therapy a complete healing of digital necrosis was observed. There was no recurrence during the 6 month-follow-up. This observation demonstrates that cannabis may represent a possible cofactor in the pathogenesis of arteritis in young smokers. Early recognition is important to avoid irreversible complications such as loss of digits.

Ring-shaped vortex domain in type-II superconductors.

We present results of experiments in superconducting niobium and numerical simulations showing the creation of a metastable ring-shaped vortex domain by heating. Such vortex rings, if pinned by structural defects, can exist forever.

[Experimental pathobiochemistry research of the knee joint fluid of ice hockey players and alpine skiers after sport injuries]. / Experimentelle Untersuchung zur Pathobiochemie von Kniegelenksergüssen bei Eishockeyspielern und Skisportlern nach Sportverletzungen.

26 knee joint fluids, conditioned by injuries, of ice hockey players and alpine skiers had been analysed. The examination of the joint fluids were followed by 17 biochemical parameters, which were fixed before. The analysis of synovial fluid allows a differentiation between an inflamed and non-inflamed process. As a measure for the inflamed enzymatic potence appears the increase of the PMN-Elastase-Concentration with a relative lack of alpha1-Antitrypsin. The proteolytic potence of the PMN-Elastase is additional intensified by the parallel increase of the LDH-Activity and therewith linked to the oxidative tissue damage. Consequently, the altered synovial fluid of traumatised knee joints is an important factor of posttraumatic damage of cartilage. The biochemical analysis of traumatised knee joint fluids heads to identify these enzymes and therewith linked to the chance of treatment with appropriate enzyme inhibitiors. This leads to a reduction or even partly to a prevention of traumatised damage of cartilages.

Ten years of ice hockey-related-injuries in the German Ice Hockey Federation - A Ten Year Prospective Study/523 International Games -.

Since January 1986 all injuries in players of the German national hockey teams (juniors A/B and seniors A/B), which have occurred during international competitions, have been registrated and evaluated by using a strict definition of injury, standardized reporting strategies and diagnosis by the team physician. Patterns of injury have been identified and correlations between position, zone and cause of injury could be analysed and, as a consequence, measures were taken to prevent them. A total of 147 injuries forcing a consecutive absence from the game during 523 international games of the German national teams were reported. During the 10 year period there was a marked decrease of the total number and incidence of injuries. In addition, injury rate and average absence from game time improved. There were more frequent concussions of the brain but the total number of facial injuries dropped after the introduction of a visor and the full face mask especially in junior hockey. The forward was the position most at risk to be injured and most injuries were caused by players contact.