[Stimulation of osteoblasts in skeletal metastases--a quantitative study]. / Die Stimulation von Osteoblasten in Skelettmetastasen--eine quantitative Untersuchung.

In almost 80% of all skeletal metastases of carcinoma of the prostate, osteoneogenesis by "normal" osteoblasts can be detected in the surrounding tissue. The object of the present study was to perform a quantitative histomorphometric analysis of this local osteoblast stimulation. In tissue with metastases, the relative proportion of osteoid and mineralized bone tissue per unit of volume (Vv = 46%) was three times higher than the norm (Vv = 15%). Although the lamellar spongiosa (Pm = 19%) was only slightly higher than the physiological values (Pm = 15%), a considerable increase in fibrous bone tissue (PFK = 39%) was found (normal value: 1-2%). The volumetric density of the osteoid (POST = 7%) had also increased (normal value: 7%). While the mean width of the trabecula of the lamellar spongiosa was within normal range (dTRAB/LK = 136 microns), appositional accumulation of a 62 microns thick fibrous bone layer resulted in a distinct tumefaction of the trabeculae. The width of the osteoid border (dapp.OST) was 22 microns (normal value: 13 microns). The majority of the activated osteoblasts were 30-150 microns from the neighboring tumor cells.

[The surgical treatment of acromioclavicular joint separation with a resorbable PDS cord]. / Die operative Behandlung der Akromioklavikulargelenk-Sprengung mit einer resorbierbaren PDS-Kordel.

Osteosynthetic complications in surgery of acromioclavicular separations are common. Also, one more intervention is necessary for removing the metallic implants. Use of self-resorbing materials resolves such disadvantages. One more indirect surgical method is presented. After reposition of dislocated acromioclavicular joint and suture of the disrupted ligaments clavicula is fixed to the coracoid processus by a cord of polydioxanone (= PDS). Early postoperative mobilisation without risks is possible in cooperative patients. Self-resorbing implants don't modify the well known indications of conservative and operative treatment.

[Fractured Monteggia pseudarthrosis. An unusual case]. / Gesprengte Monteggia-Pseudarthrose. Ein ungewöhnlicher Fall.

The diagnosis of an ulnar fracture is easily made in Monteggia lesions, but dislocation of the radial head can occasionally be overlooked. In the case presented luxation persisted and ulnar pseudarthrosis developed. In spite of functional disorders, however, the patient still managed to work for 36 years as a lorry driver. An unusual feature of this case is that 40 years after the primary event traumatic fracture of the pseudarthrotic ulna developed and was managed by bone grafting, with good functional results.

Massive pelvic osteolysis in the Gorham-Stout syndrome.

Massive osteolysis is a very rare tumour-like lesion usually affecting young adults. There are 132 reported cases which we have reviewed, including 31 single cases of pelvic involvement. The term "massive osteolysis" is based on the typical radiological findings, such as increasing translucency and loss of bone density. The diagnosis of the Gorham-Stout syndrome must be confirmed by the microscopic finding of intramedullary vascular structures. Our patient was a 23 year old white Caucasian, who had the full clinical signs of Gorham-Stout syndrome. She had achieved 2 normal pregnancies and deliveries in spite of her massive pelvic osteolysis.

[Clinical experiences in the treatment of humeral shaft fractures with the Sarmiento brace]. / Klinische Erfahrungen bei der Behandlung von Oberarmschaftfrakturen mit dem Sarmiento-Brace.

13 humeral shaft fractures were treated by Sarmiento-brace. Fracture-bracing is a special conservative traumatological management, that permits early remedial gymnastics. Light weight, optimal cosmetic results and quickly rehabilitation of the injured arm are favorable. Cooperation in gymnastics and controls within short times by the doctor are necessary. All our patients of ages under 45 years achieved nearly normal articular function, that increases 95% in comparison to the opposite arm. External rotation and abduction of the shoulder decreased in elder persons. Loss of function could not be avoided completely in critical cases (upper and lower part of the humeral shaft). Side effects were swelling, angulation deficiencies up to 16 degrees and skin lesions. The rate of pseudarthrosis seems very small. In advanced cases of malignomas pathologic fractures were treated by bracing palliatively. Open fractures, vascular damage, nerve palsy, fractures that cannot be controlled by non operative means and multiple injured patients should be treated by operation.

[Unusual, tumor-like calcinosis in scleroderma. Thibièrge-Weissenbach syndrome]. / Ungewöhnliche, tumorartige Verkalkung bei Sklerodermie. Thibièrge-Weissenbach syndrome.

In patients with progressive scleroderma, interstitial calcifications are present to a varying extent. They are mostly located in the soft tissues of the fingers, resembling points, commas or dashes. They may also appear as "calcinosis universalis" and reach a considerable size. Thus they mimic proliferative tumors. Scintigraphy, proving the existence of further calcifications can be helpful. We report the case of a female patient who presented with such a "pseudotumor" of unusual size, site and extent in the lumbar region.

Histomorphometric analysis of osteoclastic bone resorption in metastatic bone disease from various primary malignomas.

The present study deals with qualitative und quantitative analysis of osteoclastic bone resorption in metastatic bone disease. 267 cases were examined histomorphologically and divided into three developmental stages. In the first 'phase of early appearance' no bone resorption takes place. The stimulation of osteoclastic resorption in the surroundings of tumour tissue is typical in the second 'phase of interaction'. Pressure atrophy, aseptic necrosis and osteolysis by the tumour cells themselves are other mechanisms of bone destruction in the last 'phase of carcinomatosis'. Because osteoclasts are exclusively responsible for the loss of bone tissue in the 'phase of interaction', this stage is suited for precise quantitative analysis of osteoclastic resorption. 24 pure osteolytic secondary bone tumours of various primary lesions were examined histomorphometrically. The numerical values were compared with each other and with standard values of healthy individuals. In contrast with normal bone tissue the fractional resorption surfaces und osteoclast indices increase in metastases. Activated osteoclasts are larger and have more nuclei. The numbers of osteoclast index and nuclei per osteoclast are significantly higher in renal than in breast carcinoma. Osteoclasts can be activated in distances of more than 500 micron from tumour tissue. The mean stimulation distance in metastasis from squamous cell carcinoma is markedly higher than in secondary bone tumours of breast carcinoma. Several osteoclast activating substances and divers mechanisms of stimulation might be responsible for different numerical values of morphometric parameters in metastases from various primary malignancies.

[Problem of biological tolerance of vessel prostheses from dacron and synthetic fibre material]. / Zur Frage der biologischen Verträglichkeit von Gefässprothesen aus Dacron und synthetischem Fadenmaterial

In human beings there have been no observations of heterogenous sarcoma after application of macromolecular artificial implants although such materials have been applied for the last 25 years. Only benign granulomas and inflammatory processes have been described. This paper describes the appearance of double-refraction artificial particles in macrophages and in granulomas encapsulated in the neighborhood of Dacron arterial prosthesis and synthetic suture materials. These processes are possibly an expression of a biological discharge of the implants.

[Production of histological preparations from implanted vascular protheses (author's transl)]. / Die Herstellung histologischer Präparate von implantierten Gefässprothesen

The above mentioned method is suitable for the production of intact histological preparations of implanted vascular protheses. An even mounting of the sections is as possible as the application of the usual staining procedures except those containing methanol or any other agent dissolving collodion.