[Long-term results of Imhäuser osteotomy for chronic slipped femoral head epiphysiolysis]. / Langzeitergebnisse der Imhäuser-Osteotomie bei Epiphyseolysis capitis femoris lenta.

BACKGROUND: The treatment of slipped capital femoral epiphysis (SCFE) has produced in its complexity a great deal of discussion. One well-established method of operative treatment is the corrective intertrochanteric osteotomy according to Imhäuser. This study presents the clinical and radiological long-term results and the biomechanical impacts of this invasive intervention. PATIENTS AND METHODS: A total of 28 patients with chronic SCFE with slip angles between 30° and 60° were treated by Imhäuser osteotomy at an average age of 13.7 years (SD± 2.2 years, range 9-19 years) and were reexamined after an average period of 24 years (SD± 6.7 years, range 12-32 years). RESULTS: The results of the biomechanical analyses indicated an increase of force affecting the articulating joint postoperative compared to preoperative, even though the pressure on the joint decreased. This can be interpreted as a result of the enlargement of the articulating joint surface. Of the patients 17 achieved an excellent Harris hip score, 8 a good and 3 a satisfying result in the clinical assessment. There were significant differences in the degree of arthrosis between the side with and the side without osteotomy. Out of 27 cases 10 showed a decrease in the degree of arthrosis of the side with osteotomy whereas 3 cases showed an increase. In 14 cases no difference was measured. CONCLUSIONS: Despite the valgisation the Imhäuser osteotomy relieves the hip joint thus probably counteracting degenerative alterations even though being unable to fully prevent this progress. The good biomechanical, clinical and radiological results support indications for Imhäuser osteotomy for slip angles between 30° and 60°.

[Renal cell cancer does not show a typical perfusion pattern in contrast-enhanced ultrasound]. / Nierenzellkarzinome zeigen kein typisches Perfusionsverhalten in der kontrastverstärkten Sonografie.

PURPOSE: Grayscale ultrasound has improved the outcome of renal cell cancer (RCC), since most significant RCCs are discovered coincidently during routine abdominal ultrasound examinations. The CT scan is currently the method of choice for further evaluation. The therapeutic approach depends on the results of the CT scan. The purpose of this study was to evaluate whether RCCs would show typical vascularization patterns in contrast-enhanced ultrasonography (CEUS). METHODS AND MATERIALS: We examined 30 patients with solid renal tumors before surgery with CEUS using the microbubble contrast agent SonoVue (Bracco, Italy). All patients had suspected malignant lesions on a CT scan. The examination was performed with an Acuson Sequoia (Siemens, Erlangen, Germany) with a low mechanical index (low MI) using the contrast agent imaging method "contrast pulsed sequencing" (CPS). We looked at the vascularization in the early phase (< 30 s) and the late phase (60 - 120 s). These findings were compared to the histopathological results. RESULTS: 25 (83 %) had an RCC, and two (7 %) patients showed an urothelial carcinoma. Benign tumors were diagnosed in three (10 %) patients. All of them were oncocytomas. In grayscale ultrasound 52 % of the RCCs were hypoechoic, 36 % isoechoic, and 12 % hyperechoic. After the application of the contrast agent, all RCCs showed a chaotic vascularization pattern. In the early phase (< 30 s), 12 tumors showed hyperperfusion, three showed isoperfusion, and nine showed hypoperfusion. During the late phase (60 - 120 s), five tumors showed hyperperfusion, nine showed isoperfusion, and ten showed hypoperfusion. One small cystic tumor did not indicate contrast enhancement at any time. CONCLUSION: In our study RCC showed chaotic vascularization in CEUS without typical vascularization patterns.

Plasmacytoid urothelial carcinoma of the bladder: histological and clinical features of 5 cases.

PURPOSE: Urothelial carcinoma with plasmacytoid morphology is a rare and only recently described histological variant. To date only 22 cases have been published. We present clinical and histopathological features of 5 cases of plasmacytoid urothelial carcinoma at our institutions. MATERIALS AND METHODS: From a consecutive series of 130 muscle invasive urothelial carcinoma cases 3 of plasmacytoid urothelial carcinoma (2.3%) were identified. Two additional plasmacytoid urothelial carcinoma cases, including 1 that was noninvasive, were also studied. Data were collected from clinical charts, histological review and followup. RESULTS: Four patients had a muscle invasive tumor at first presentation. The nonmuscle invasive plasmacytoid urothelial carcinoma represents the second published case in the literature. Conventionally differentiated urothelial carcinoma was focally present in every case. Plasmacytoid urothelial carcinoma cells were dyshesive and showed abundant eosinophilic cytoplasm, leading to a plasmacytoid appearance. Positive staining for epithelial markers confirmed the epithelial nature of the tumor. All tumors showed negative E-cadherin expression. Adjuvant or neoadjuvant chemotherapy seemed to have a beneficial effect on survival in patients with advanced tumors since they experienced prolonged survival. CONCLUSIONS: Plasmacytoid urothelial carcinoma is a rare variant of urothelial carcinoma with defined clinical and pathological characteristics. Diagnostic pitfalls are missing hematuria and no grossly identifiable tumor despite muscle invasive tumor stage. Cases only show mucosal induration and thickened bladder walls. Our data raise the possibility that the loss of E-cadherin expression is a prerequisite for plasmacytoid urothelial carcinoma. Awareness of these aspects should lead to earlier diagnosis and improved long-time survival in patients with plasmacytoid urothelial carcinoma.

[Multimodal therapy for bladder sparing with high grade bladder tumors]. / Multimodale Therapien zum Blasenerhalt bei High-grade-Blasentumoren.

The demographic changes of our society, with an increasing number of elderly patients and higher comorbidity, leads to the fact that managing transitional cell carcinoma (TCC) in the elderly is becoming increasingly more important. Thus, the value and indication of conservative or less invasive treatment approaches have to be continuously re-evaluated. The gold standard of treatment for invasive high grade TCC is radical cystectomy with curative intent. However, not each and every patient is suitable for this procedure or the operation is rejected. Thus, alternative treatment options (curative or palliative) including bladder sparing approaches should be offered to this group of patients. These include transurethral resection (TUR-B), open partial cystectomy, chemotherapy (intravesical or systemic), local radiation and minimally invasive interventional therapies alone or in combination. A lower physical and mental burden and, more important, a faster convalescence and the maintenance of the quality of life, are the major aims of these strategies. From an oncologic point of view these concepts have to be viewed with caution, since they may only lead to a temporarily stable disease or the elimination of symptoms. However, long-term follow-up demonstrates that with the correct indication for a multi-modal treatment, a subset of patients with high grade TCC of the bladder may be cured when implementing a bladder sparing approach.