Solitary plasmacytoma of thoracic vertebra in a woman with Lynch syndrome: A case report.

INTRODUCTION: One of the major disabling health conditions among elderly is back pain due to degenerative diseases. Less than 1% of spine disorders are caused by malignancies. Among the rare primary vertebral neoplasms the multiple myeloma and the plasmacytoma account for 26% of these cases. PRESENTATION OF CASE: We are reporting a case of 64 year-old woman, who suffered from progressive upper back pain and intermittent neurological symptoms including lower limb weakness and voiding disorder under axial loading. Her medical history includes a Lynch syndrome (LS). Computed tomography (CT) and magnetic resonance imaging (MRI) detected a single malignant osteolytic process of the spine involving T5. Urgent surgery with laminectomy intralesional tumor removal and posterior stabilization (Th4-Th6) due to unstable pathologic fracture with spinal cord compression was conducted after interdisciplinary decision. Histopathological examination of the tumor revealed a solitary plasmacytoma. DISCUSSION: To our knowledge this is the first case report of a solitary plasmacytoma of the bone (SPB) that arise in a patient who suffers from LS. Similar DNA mismatch repair malfunction is existent in LS and SPB. Hence, a hereditary correlation might be imaginable. CONCLUSION: When detecting a lytic spinal tumor in a patient who suffers from LS a SPB should be taken under consideration.

[The third compartment in knee endoprosthetics: from denervation to replacement, which therapy is correct?]. / Das dritte Kompartiment bei der Knieendoprothetik : Von Denervierung bis Ersatz, welche Therapie ist die richtige?

Involvement of the patellofemoral compartment is common in osteoarthritis of the knee but to date there is no consensus as to the most appropriate approach concerning the patella. Both general non-selective resurfacing as well as selective or secondary resurfacing are currently accepted. However, despite abundant studies on the subject no clear conclusions can be drawn from the available evidence. There are arguments in favour of either approach. Accordingly, no strong evidence can be found to support peripatellar denervation. With the advent of new diagnostic modalities for the assessment of knee osteoarthritis, such as single photon emission computed tomography/CT (SPECT/CT), a more selective approach to patellar resurfacing with a potentially improved outcome might become possible.

[Idiopathic orbital inflammation syndrome in childhood--case report and literature review]. / Idiopathische orbitale Entzündung im Kindesalter--Fallbericht und Literaturreview.

BACKGROUND: Idiopathic orbital inflammation syndrome (IOIS) is a rare disease in childhood. There are only ca. 70 case reports in the scientific literature. METHOD: We present a case report and review of literature. CASE REPORT: A 6-year-old girl developed within one week beginning with a discrete, non-traumatic haemorrhage of the lower palpebra a painful proptosis, periorbital swelling, conjunctival chemosis and injection and motility restriction to lateral gaze of the right eye. MRI showed a retrobulbar and eyelid mass with enhancement and signs of haemorrhage without optic nerve involvement. A rapidly performed biopsy excluded malignancies and confirmed the diagnosis of non-specific inflammation. With high-doses of intravenous and later oral prednisolone the symptoms improved significantly. Because of an impairment under tapering of prednisolone an interim elevation of the dose was necessary, but with very slow tapering over 4.5 months the girl became symptom-free except for a minimal, non-relevant abduction deficit. There has been no recurrence in the last 1.5 years. DISCUSSION: In comparison to the clinical features of adults the rarely reported childhood cases show no relevant differences in orbital signs, frequency of bilaterality and pain, recurrence rate and success of therapy. Only iritis and papilloedema seem to be special features of childhood IOIS, these cases tend to a higher rate of recurrences. Histopathological examination is much more necessary than in adults because of the need for exclusion of rhabdomyosarcoma. Our case shows that haemorrhages can also be a sign for an IOIS.

[Screening of modified polyethylene surfaces for tissue engineering of chondrocytes]. / Screening von modifizierten Polyethylenoberflächen für das Tissue-Engineering von Chondrozyten.

BACKGROUND: Reconstructive surgery needs high requirements of substitutes for cartilages. The availability of autologous material is limited. The use of implants can cause inflammatory reactions. Therefore the biocompatibility of porous polyethylene should be improved by masking the synthetic surface with autologous cells. The polyethylene surface was functionalized by collagen, in order to enhance the contact between polyethylene and the surrounding cells. METHODS: The modified surfaces were characterized and tested by an in vitro screening with primary human chondrocytes. RESULTS: The modification of polyethylene surfaces by collagen coating increased the life time of chondrocytes growing at this surface. The effect was independent of the former functionalization. CONCLUSIONS: It is possible to cultivate chondrocytes on polyethylene surfaces. The results have to be proven in a long-term animal experimental study.

[Idiopathic orbital inflammatory syndrome (orbital pseudotumors): diagnosis and therapy]. / Idiopathische entzündliche intraorbitale Fibrosklerose: Diagnostik und therapeutische Möglichkeiten.

BACKGROUND: Pseudotumors of the orbit comprise a group of idiopathic inflammatory processes and are, except for endocrine orbitopathy, the most common reason for exophthalmos in adults. Orbital pseudotumors, also called idiopathic orbital inflammatory syndrome (IOIS), can be determined from orbital involvement in systemic fibrosing diseases. Finding the correct diagnosis can be challenging. Due to the topographic relations of the orbit to neighbouring structures, a multidisciplinary cooperation is highly recommended. CASE REPORT: We report a case of a 42-year-old woman with unilateral exophthalmos. Additionally we found impaired motility of the affected bulbus, ptosis and reduction of visual acuity. Orbital MR imaging demonstrated dense fibrotic masses filling the whole orbita including the extraocular muscles as well as the optic nerve. Tissue specimens were extracted while performing orbital decompression via a lateral orbitotomy. Histological examination revealed a lymphatic infiltration and fibrotically destroyed tissue containing the lacrimal gland. After surgical decompression, oral steroid therapy and immunotherapy, a recovery of the visual loss could be seen. CONCLUSIONS: Intraorbital fibrosclerosing pseudotumors often require a difficult long-term treatment. Therapeutic options are steroid therapy, immunotherapy, radiotherapy and surgery. The diagnostic steps include blood tests, ultrasound, CT and/or MRI as well as histological differentiation. Solid tumors and orbital involvement in diseases of the hematopoetic system have to be excluded. Since intraorbital fibrosis can be accompanied by manifestations in various other organs, a complete investigation of the body and thorough follow up are crucial.

[Erdheim-Chester disease as differential diagnosis in bilateral exophthalmos]. / Die Erdheim-Chester-Krankheit als Differenzialdiagnose bei beiderseitigem Exophthalmus.

This report describes the case of a patient who had symmetrical exophthalmos, periorbital xanthelasmas and reduced vision. Next to Wegener's granulomatosis the differential diagnosis of Erdheim-Chester disease is discussed. It concerns a rare systemic histiocytosis of unknown etiology. Above all, the skeleton system with symmetrical long bone osteosclerosis is affected. Manifestations in the area of the orbit have seldom been reported with bilateral retrobulbar infiltrations, exophthalmos, diplopia, compression of the optic nerve and periorbital xanthelasmas.

[Materials used in reconstructive surgery of the orbit]. / Materialien in der rekonstruktiven Orbitachirurgie.

Orbital traumas and tumour operations may cause defects the operative management of which sets high requirements on the surgeon. For covering defects, transplants or implants are available. There is a risk of inflammation due to the free contact of the implants to the cavity of the inner nose or the sinus. Today, implants made from titanium, porous polyethylene, PDS (poly-p-dioxanon) foils, and ceramic materials are preferred. Alternatively, autogenous transplants can be used. These are immunologically harmless but they are of only limited availability. Moreover, a second operation for taking the transplants with creation of a donor defect is necessary.

[The ring-pin anastomosis technique. Long-term clinical experiences with the mechanical ring-pin system for microvascular anastomoses in reconstructive head and neck surgery ]. / Ring-Pin-Anastomosentechnik. Klinische Langzeiterfahrungen mit dem mechanischen Ring-Pin-System für mikrovaskuläre Anastomosen in der rekonstruktiven Kopf-Hals-Chirurgie.

BACKGROUND: Microvascular anastomosis remains one of the most critical aspects of free tissue transfer. Since microsurgical suture techniques are complicated and time-consuming, other techniques of anastomosis have been created. One of these is the ring-pin system. METHODS: Between January 1996 and October 2001, 48 patients underwent reconstruction with a free radial forearm flap. In 20 patients the venous anastomosis was carried out using a ring-pin system with end-to-end technique. The clinical results were compared to the other 28 patients in whom the anastomosis was sutured with 9-0 prolene. RESULTS: In the group using ring-pin anastomosis ( n=20), two flaps showed venous congestion within 24 h postoperatively. After revision the flaps were well perfused. In the other group with sutured vessels ( n=28), a transplant became ischemic in one patient due to venous thrombosis and had to be partly removed. The time of anastomosis was considerably shortened by the use of the ring-pin system. CONCLUSIONS: The venous end-to-end-anastomosis using the ring-pin system can be carried out relatively easily and rapidly after a comparatively short period of training. Long-term results have shown good tissue tolerance of the material and sufficient blood circulation of the grafts.

Lipid analysis of follicular casts from cyanoacrylate strips as a new method for studying therapeutic effects of antiacne agents.

BACKGROUND: The cyanoacrylate follicular biopsy is an established method for the examination of the horny layer and quantitative assessment of microcomedones. We have optimized the method by separating follicular casts mechanically from the cyanoacrylate strips. OBJECTIVES: To use this method to analyse topical therapy-induced changes of the lipid composition in the sebaceous follicular infundibulum. METHODS: Both the follicular casts and the residual skin surface strip, the last representing a mixture of stratum corneum and surface lipids, were extracted twice with n-hexane-ethanol under ultrasonication, evaporated, redissolved in chloroform-methanol and separated by high-performance thin layer chromatography, using cholesterol sulphate, cerebroside, ceramide types 3 and 4, cholesterol, oleic acid, triolein, cholesterol oleate and squalene as standards. Identification was performed by computer-assisted densitometric analysis. Six patient groups receiving adapalene 0.1%, tretinoin 0.025%, clindamycin 1%, clindamycin 1% + tretinoin 0.025%, benzoyl peroxide 5% or benzoyl peroxide 5% + erythromycin 2% were investigated before and 12 weeks after application. RESULTS: A significant decrease in free fatty acid proportions combined with an increase in triglycerides was observed in the groups receiving antimicrobial therapy, supporting the hypothesis of lipolysis due to microbial colonization. The groups treated with topical retinoids showed an additional significant increase in ceramide subfractions, most probably reflecting their influence on epidermal keratinization. CONCLUSIONS: Our method proved suitable for the detection of quantitative and qualitative changes in lipid profiles of both infundibulum cast content and surface lipids. It enabled simple, non-invasive and objective assessment of the most relevant lipid classes in the sebaceous infundibulum, and efficient monitoring of drug effects on the follicular infundibulum.

Age and sex variation in lipid composition of human fingernail plates.

In contrast to epidermal lipid metabolism, the lipid biochemistry of nails has yet been poorly investigated. Our purpose was to define a reference population of healthy individuals as a base for the better understanding of nail diseases and age-induced changes. Therefore, we developed a method of processing and extracting the nail plates enabling us to assess the most relevant epidermal lipid classes by HPTLC. Our study revealed that nail plate lipid composition varies with age and sex: the lipid composition of the fertile years shows distinct profiles compared to that of childhood and old age, suggesting an influence of sex hormones on nail lipogenesis. Our results open the possibility in the future of an easier comparison between healthy and diseased nails and enable us to investigate factors influencing nail lipid composition such as drugs, metabolic diseases, toxic agents, cosmetics and nail therapeutics.

Improved method for studying skin lipid samples from cyanoacrylate strips by high-performance thin-layer chromatography.

A non-invasive method for sampling skin surface lipids is cyanoacrylate stripping (CAC-TS). It was the purpose of our study to improve the method for sampling of skin surface lipids and the separation of epidermal lipid fractions by a modification of the methods described by Melnik and by Imokawa et al. Briefly, lipids on the glass slide sampled by CAC-TS from the forearm of 75 volunteers and from the forehead of 60 volunteers were eluted in hexane/ethanol under ultrasonication. Identification of the diluted total superficial sebaceous and epidermal skin lipids was performed by sequential high-performance thin-layer chromatography. For quantification of the lipids we used densitometric methods. By this modified method we were able to show a clear and complete separation of all relevant lipids from a cyanoacrylate strip that represented 1-2 mg stratum corneum only.