[Operative treatment of scoliosis : Preoperative planning, intraoperative monitoring, and postoperative management]. / Operative Behandlung von Skoliosen : Präoperative Planung, intraoperatives Monitoring und postoperatives Management.

BACKGROUND: The indication for the surgical treatment of thoracic, lumbar, combined, and thoracolumbar idiopathic and neuropathic scoliosis is a Cobb angle of more than 50° in the thoracic and more than 45° in the lumbar spine. The success of the operation is highly dependent on the pre-operative indication. Standardized medical imaging and close collaboration with anesthetists and pediatricians are necessary in complex cases. METHODS: We developed a screening routine in which pre-operative diagnosis is performed during hospitalization. The concept is individually developed across disciplines. Surgery for childhood scoliosis always presents a particular challenge for anesthetists and surgeons. Close collaboration during surgery is indispensable for guaranteeing success. Risk factors are determined, evaluated and-if necessary-treated before performing surgery. These factors are also strictly monitored and dealt with during surgery. RESULT: Regular post-operative check-ups are required to ensure early determination and adequate treatment of complications. CONCLUSION: Operative treatment of scoliosis should only be performed in medical centers that allow for close collaboration and diagnostic investigation.

[Indications for deformity correction with minimally invasive spondylodesis]. / Indikationen für eine Formkorrektur mittels minimalinvasiver Spondylodese.

The indications for surgical treatment of thoracic, lumbar, combined and thoracolumbar scoliosis are given for a curvature of the thoracic spine with a Cobb angle more than 50° and more than 45° in the lumbar spine. The maximum Cobb angle is 90°. The aim is the correction of more than 50% in the frontal plane and correction of scoliosis is possible in flexible curvatures up to 90%. By the minimally invasive surgical technique the muscular damage is completely avoided on the convex side but on the concave side this is only partly possible. This is the first report of a muscle preserving minimally invasive surgical technique for the convex side of scoliosis.

Soluble p185(HER-2) in patients with malignant bone tumours.

BACKGROUND: This study was initiated to test the hypothesis that soluble p185(HER-2) could be of value as a diagnostic or predictive marker for patients with malignant bone tumours. PROCEDURE: Sera of 35 patients with high-grade malignant osteosarcoma (n = 27) and Ewing Sarcoma (n = 8) were tested at the time of diagnosis by ELISA and compared with sera of controls (n = 38) and clinical data. RESULTS: In patients with osteosarcoma and Ewing Sarcoma, levels of sp185(HER-2) did not differ significantly from levels in controls. These results were irrespective of the type of tumour, survival chemotherapy or other clinical variables. CONCLUSION: p185(HER-2) serum levels do not appear to be of diagnostic or predictive value for differentiation of high-grade osteosarcoma and Ewing Sarcoma.

Serum levels of TNF-beta and sTNF-R in patients with malignant bone tumours.

OBJECTIVE: To determine serum levels of TNF-beta and soluble TNF-R in patients with primary highly malignant bone tumours. PATIENTS AND METHODS: Sera of 27 patients with highly malignant osteosarcoma and Ewing sarcoma were taken at the time of diagnosis and analysed by ELISA. RESULTS: Both TNF-beta and sTNF-R levels were lower in sera from osteosarcoma patients as compared to those from Ewing sarcoma. In patients with high-grade osteosarcoma, but not Ewing sarcoma, high levels of TNF-beta correlated with bad response to neoadjuvant chemotherapy. CONCLUSION: In patients with high-grade osteosarcoma TNF-beta levels seem to be of predictive value and both TNF-beta and sTNF-R seem to be of diagnostic value for differentiation between high-grade osteosarcoma and Ewing sarcoma.