bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuroendokrine Tumoren des Gastrointestinaltrakts: Molekulare Charakterisierung auch bei NET immer wichtiger
Authors: Gulden Josef
Published: March 2018

Die US-amerikanische SEER-Datenbank enthält mehr als 35 000 neuroendokrine Tumoren (NET). Davon entfallen 58% auf den Verdauungstrakt, 6,4% betreffen das Pankreas, 17,2% den Dünndarm und 27,4% Dickdarm und Rektum einschließlich Appendix. Um diese Lokalisationen ging es bei einem Symposium im Rahmen des Deutschen Krebskongresses.
Integrative Therapie des Mammakarzinoms: Mehr Fragen als Antworten
Authors: Kaden Marion
Published: March 2018

Welche Möglichkeiten stehen Ärzten bei der Integrativen Therapie des Mammakarzinoms zur Verfügung, und was macht diese überhaupt aus? Die Beantwortung dieser Fragen scheint selbst für viele Experten der Integrativen Onkologie eine Herausforderung darzustellen, wie sich bei einem Fachkongress anthroposophischer Ärzteverbände zum Thema Mammakarzinom zeigte. So konnten die spezifischen Besonderheiten oder medizinischen Vorteile der Integrativen Onkologie für die „schulmedizinische Onkologie“ – als vorgeblich notwendiger Ergänzung des onkologischen Leistungsspektrums – nur unbefriedigend dargestellt werden. Bei zahlreichen ärztlichen Kongress- und Workshop-Teilnehmern blieb angesichts dessen oft nur Hilf- und Ratlosigkeit. Zudem entspricht die von einigen angeführte einfache Formel „Integrative Onkologie = Onkologie + Komplementärmedizin“ nicht den, vor allem aus den USA stammenden, teilweise seit Jahrzehnten erprobten und wissenschaftlich fundierten Konzepten.
Prostatakarzinom: Offene Fragen – neue Antworten
Authors: Kretzschmar Alexander
Published: March 2018

Beim Prostatakarzinom gibt es im Vergleich zur anderen großen urologischen Tumorentität, dem Nierenzellkarzinom, noch diagnostischen und therapeutischen Nachholbedarf. Auf der 27. Jahrestagung der European Association of Urology (EAU) wurden kontroverse Themen wie PSa-Screening und das Vorgehen bei High-Risk-Patienten diskutiert. Hoffnungsvoll stimmen einige Daten mit neuen zielgerichteten Therapien.
Neue explorative Analyse der ATAC-Studie: Adipöse Frauen haben häufiger Rezidive
Authors: Kretzschmar Alexander
Published: March 2018

Adipöse Frauen mit Mammakarzinom im Frühstadium haben eine schlechtere Prog-nose. Diese klinische Beobachtung wird durch eine neue Auswertung der ATAC-Studie bestätigt. Die Rezidivraten waren in allen BMI-Quintilen bei Anastrozol niedriger als bei Tamoxifen.
Krebs und HIV-Infektion
Authors: Skaletz-Rorowski A. , Brockmeyer N.H. , Potthoff A.
Published: March 2018

Tumore sind die zweithäufigste Todesursache von HIV-Patienten. Die Prävalenz von Tumorerkrankungen liegt in der nationalen Kohorte des BMBF-geförderten Kompetenznetzes HIV/ AIDS bei 8,9%. Das Kaposi-Sarkom ist mit 349 Fällen der am häufigsten dokumentierte Tumor. HHV-8 assoziierte Tumore (z. B. das Kaposi-Sarkom) werden durch molekulare Mimikry vermittelt. Die Optimierung der HIV-Therapie bleibt die wichtigste therapeutische Maßnahme. Chemotherapeutika werden bei den verschiedenen Tumorentitäten mit unterschiedlichem Erfolg eingesetzt. Während die Inzidenz des Kaposi-Sarkoms und der Non-Hodgkin-Lymphome nach Einführung der antiretroviralen Therapie deutlich abgenommen hat, nehmen nicht AIDS-definierende Tumore zu. Der häufigste nicht-AIDS definierende Tumor im Kompetenznetz ist das Analkarzinom mit 192 Fällen. HPV-Infektionen und Rauchen sind hierbei wichtige Risikofaktoren. Eine maximale Virussuppression, ein früher Beginn der antiretroviralen Therapie, Impfungen (gegen Hepatitis und HPV) und Screeningmaßnahmen (z. B. Proktoskopien) können Tumoren vorbeugen.
Strahlenexposition in Europa nach Tschernobyl 1986: Leukämierisiko auch in Ländern mit geringer radioaktiver Belastung erhöht
Authors: Bischoff Angelika
Published: March 2018

Das Risikomodell der International Commission on Radiological Protection (ICRP) zur Gesundheitsgefährdung, welches das Risiko externer Strahlung auf der Basis externer Expositionsstudien erfasst, unterschätzt das Gesundheitsrisiko einer chronischen internen Strahlenexposition. Diese Folgerung ziehen britische Wissenschaftler aus einer Studie, welche die radioaktive Strahlenexposition Ungeborener in Deutschland, Griechenland und Großbritannien nach der Reaktorkatastrophe von Tschernobyl 1986 untersuchte.
Adenokarzinom des gastroösophgealen Übergangs Typ I und II: FDG-PET identifiziert früh Patienten mit ungünstiger Tumorbiologie
Authors: Kretzschmar Alexander
Published: March 2018

Die in San Francisco vorgestellten Ergebnisse der MUNICON II-Studie bestätigen bei Patienten mit einem Adenokarzinom des gastroösophgealen Übergangs Typ I und II (AEG Typ I und II) den prognostischen Stellenwert einer frühen PET-Response unter einer neoadjuvanten Chemotherapie. Eine Salvage-Radiotherapie führt bei metabolischen Nonrespondern aber zu keiner entscheidenden Prognoseverbesserung.
Keimzelltumore des Hodens: Risikofaktoren und Langzeittoxizität
Authors: Kretzschmar Alexander
Published: March 2018

Die Inzidenz von Keimzelltumoren des Hodens nimmt seit den vergangenen 50 Jahren kontinuierlich zu. In Deutschland sind jährlich etwa 4700 Männer betroffen. Bei mehr als 95% der Hodentumore handelt es sich um Malignome. Heute können rund 80% der Männer dauerhaft geheilt werden. Daher ist es wichtig, prognostisch wichtige Faktoren zu identifizieren, um die Inzidenz und die tumorassoziierte Mortalität senken zu können.
Differential Diagnosis of Metastases in Bone Scans: Chemotherapy induced Bone Necrosis
Authors: Kaiserling E. , Klingebiel T. , Feine U. , Niethammer D. , Reuland P.
Published: March 2018

Aim: Influenced by the incorrect diagnosis of a bone metastasis caused by bone necrosis we evaluated reasons and frequency of bone necrosis in patients referred for bone scanning in follow-up of tumors. Methods: Bone scans performed within two years on patients with primary bone tumors or tumors metastatic to bone were reviewed in respect to the final diagnosis bone necrosis. Results: We found the cases of three young patients who presented the appearance of hot spots on bone scintigrams which were finally diagnosed as bone necrosis. In two cases the diagnosis was based on histological findings, in one case the diagnosis was made evident by follow-up. All the three patients had been treated by chemotherapy and presented no other reason for the development of bone necrosis. Enhanced tracer uptake in all sites decreased within eight weeks up to two years without therapy. Conclusion: Single and multiple hot spots after chemotherapy may be originated by bone necrosis but mimikry metastases.
Follow-up Findings in Regional Cerebral Blood Flow (r-CBF)-SPECT in a Case of idiopathic Childhood Hemidystonia
Authors: Marienhagen J. , Aderbauer Judith , Bock Elke , Segerer H. , Eilles Chr. , Fiedler A.
Published: March 2018

A 9½-year-old girl suffered from intermitting tremor and jitteriness of her left hand and oral muscles every 4 to 6 weeks with long lasting episodes. Clinically myoclonias and dystonic positioning of the left arm, hand and facial muscles were seen. No evidence of trauma, infection or inborn errors of metabolism was found. Successful therapy with carbamazepine was initiated while L-DOPA failed. An ictal 99m-Tc-HMPAO-SPECT showed severe asymmetry with focal hyperperfusion of the contralateral right thalamus and basal ganglia as well as of the bifrontal cortex, whereas no anatomical lesions were found by MRI. In contrast, an interictally performed 99m-Tc-HMPAO SPECT showed hypoperfusion of the right thalamus and normalisation of the frontal perfusion under medical treatment. These 99m-Tc-HMPAO-SPECT findings may provide new insights into the localisation and pathophysiological pathways of idiopathic childhood dystonia.
Die Strahlenexposition des Patienten durch die Transmissionsmessung bei der Myokardperfusions-SPECT
Authors: Chapot C. , Schaefer A. , Donsch P. , Kirsch C.-M. , Seifert H.
Published: March 2018

Ziel: Ziel war die Bestimmung der Strahlenexposition des Patienten durch die Transmissionsmessung bei der Myokardperfusions-SPECT. Methode und Material: Simultan zur Emissionsmessung (Tc-99m-MIBI, A = 500 MBq) erfolgt bei der Myokardperfusions-SPECT eine Transmissionsmessung mit Hilfe einer Am-241-Linienquelle (A = 5550 MBq). Bei der Simulation der Myokardperfusions-SPECT (ohne Tc-99m-MIBI) wurden Dosismessungen mit Thermolumineszenzdosimetem unter Verwendung eines Thoraxphantoms durchgeführt. Ergebnisse: Bei einer Aufnahmedauer von 20 min ergaben sich folgende Energiedosen: Oberfläche (Xyphoid) 30 μGy, Herz 25 μGy, Lunge 14 μGy, 2. BWK 16 μGy, oberes anteriores Mediastinum 16 μGy, Leber 0 μGy. Eine Abschätzung des Verhältnisses zwischen den effektiven Dosen durch Transmissions- und Emissionsmessung (3,6 x 10-3 bzw. 4,1 mSv) ergab einen Wert von 9 x 10-4. Schlußfolgerung: Die Strahlenexposition des Patienten durch die Transmissionsmessung ist vernachlässigbar gering und damit kein limitierender Faktor im Hinblick auf die generelle Anwendung der Transmissionsmessung bei der klinischen Myokardperfusions-SPECT.
Rolle der Positronen-Emissions-Tomographie (PET) und Single-Photon-Emissions-Tomographie (SPECT) bei der sogenannten »Multiple Chemical Sensitivity« (MCS)
Authors: Grünwald F. , Herholz K. , Kuwert T. , Tatsch K. , Sabri O. , Weiller C. , Bartenstein P.
Published: March 2018

Die funktionell bildgebenden Verfahren SPECT und PET werden zunehmend genutzt, um die Existenz eines Syndroms der erworbenen Chemikalienüberempfindlichkeit »Multiple Chemical Sensitivity« (MCS) nachzuweisen. In der Folge spielen SPECT und PET-Befunde auch im Rahmen von Gutachten bei Berufskrankheiten-Anzeigen als Beweismittel eine große Rolle. In der vorliegenden Arbeit wird die zu diesem Thema existierende Literatur einer kritischen Betrachtung unterzogen. Die Autoren kommen zu dem Schluß, daß die gegenwärtig verfügbaren Daten nicht ausreichen, um die Existenz eines solchen Syndroms nachzuweisen. Die niedrige Spezifität der beschriebenen Veränderungen macht es sehr schwierig, einen kausalen Zusammenhang zu der toxischen Exposition herzustellen, und schränkt den Wert von PET und vor allem SPECT bei gutachterlichen Fragestellungen in diesem Zusammenhang ein.
Granulationsgewebe: Pitfall in der Therapiekontrolle mit F-18-FDG-PET nach Chemotherapie
Authors: Wit M. de , Buchert R. , Igel B. , Bohuslavizki K. H. , Lorenzen J.
Published: March 2018

FDG-Speicherung in Entzündungsherden als Ursache für falsch positive Befunde bei der FDG-PET in der primären Tumor- und Metastasendiagnostik ist in der Literatur belegt. Der vorliegende Fall zeigt, daß die vermehrte Speicherung von FDG in aktivierten neutrophilen Granulozyten und Makrophagen auch in der Therapieverlaufskontrolle unter Chemotherapie zu berücksichtigen ist. Bei einem 52jährigem Patienten wurde eine FDG-PET nach Abschluß der Chemotherapie eines Non-Hodgin-Lymphoms des Abdomens mit der Frage nach verbliebener Tumorvitalität durchgeführt. In der FDG-PET fand sich im Randbereich des persistierenden Restbefundes ein erhöhter Glukosestoffwechsel. Histologisch war dieser Befund auf umgebendes Granulationsgewebe mit zentralen nekrotischen Tumoranteilen zurückzuführen.
High-Activity Samarium-153-EDTMP Therapy in Unresectable Osteosarcoma
Authors: Bielack S. , Sciuk J. , Yollet B. , Jürgens H. , Schober O. , Franzius Christiane
Published: March 2018

Despite highly efficacious chemotherapy, patients with osteosarcomas still have a poor prognosis if adequate surgical control cannot be obtained. We applied high-activity Sm-153-EDTMP therapy within a multimodal therapy concept to improve local control of an unresectable osteosarcoma with poor response to initial polychemotherapy. A 21-yearold woman with an extended, unresectable pelvic osteosarcoma and multiple pulmonary metastases was treated with high-activity of Sm-153- EDTMP (150 MBq/kg BW, total 8.1 GBq). Afterwards external radiotherapy of the primary tumor site was performed and polychemotherapy was continued, followed by autologous peripheral blood stem cell reinfusion. Within 48 h after Sm-153-EDTMP application the patient had complete pain relief. After three weeks the response was documented by 3-phase Tc-99m-MDP bone scintigraphy (primary tumor and metastases: decreased tracer uptake), whole-body F-18-FDG-PET (primary tumor and metastases: diminution of glucose metabolism) and thoracic CT (metastases: reduction of size). The present case warrants further evaluation of feasibility and efficacy of this multimodal therapy combination of high-activity Sm-153-EDTMP therapy, external radiation, polychemotherapy and stem cell support for unresectable osteosarcomas.
Heterogeneity of Cerebral Blood Flow: a Fractal Approach
Authors: Hartikainen P. , Kuikka J. T.
Published: March 2018

Aim: We demonstrate the heterogeneity of regional cerebral blood flow using a fractal approach and singlephoton emission computed tomography (SPECT). Method: Tc-99m-labelled ethylcysteine dimer was injected intravenously in 10 healthy controls and in 10 patients with dementia of frontal lobe type. The head was imaged with a gamma camera and transaxial, sagittal and coronal slices were reconstructed. Two hundred fifty-six symmetrical regions of interest (ROIs) were drawn onto each hemisphere of functioning brain matter. Fractal analysis was used to examine the spatial heterogeneity of blood flow as a function of the number of ROIs. Results: Relative dispersion (= coefficient of variation of the regional flows) was fractal-like in healthy subjects and could be characterized by a fractal dimension of 1.17 ± 0.05 (mean ± SD) for the left hemisphere and 1.15 ± 0.04 for the right hemisphere, respectively. The fractal dimension of 1.0 reflects completely homogeneous blood flow and 1.5 indicates a random blood flow distribution. Patients with dementia of frontal lobe type had a significantly lower fractal dimension of 1.04 ± 0.03 than in healthy controls. Conclusion: Within the limits of spatial resolution of SPECT, the heterogeneity of brain blood flow is well characterized by a fractal dimension. Fractal analysis may help brain scientists to assess age-, sex- and laterality-related anatomic and physiological changes of brain blood flow and possibly to improve precision of diagnostic information available for patient care.
One-year Follow-up of Neuropsychology, MRI, rCBF and Glucose Metabolism (rMRGlu) in Cerebral Microangiopathy
Authors: Hellwig D. , Schreckenberger M. , Schneider R. , Kaiser H.-J. , Wagenknecht G. , Setani K. , Reinartz P. , Zimny M. , Mull M. , Ringelstein E.-B. , Büll U. , Sabri O.
Published: March 2018

Background: MRI shows lacunar infarctions (LI), deep white matter lesions (DWML) and atrophy in cerebral microangiopathy, which is said to lead to vascular dementia. In a first trial series on 57 patients with confirmed pure cerebral microangiopathy (without concomitant macroangiopathy), neuropsychological impairment and (where present) brain atrophy correlated with decreased rCBF and rMRGlu. LI and DWML did not correlate with either neuropsychological impairment or decreased rCBF/rMRGIu. This study was done one year later to detect changes in any of the study parameters. Methods: 26 patients were re-examined for rCBF, rMRGlu, LI, DWML, atrophy and neuropsychological performance (7 cognitive, 3 mnestic, 4 attentiveness tests). Using a special head holder for exact repositioning, rCBF (SPECT) and rMRGlu (PET) were measured and imaged slice by slice. White matter/cortex were quantified using MRI-defined ROIs. Results: After one year the patients did not show significant decreases in rCBF or rMRGlu either in cortex or in white matter (p >0.05), nor did any patient show LI, DWML or atrophy changes on MRI. There were no significant neuropsychological decreases (p >0.05). Conclusions: Cerebral microangiopathy ought to show progressive neuropsychological, functional (rCBF, rMRGlu) and morphological deterioration over periods >1 year. It is unlikely that direct cortical damage (e.g., incomplete infarction) is responsible for neuropsychological impairment since one-year follow-up of our patients revealed no progression of brain atrophy or any other cortical damage.
Individuelle Bestimmung der minimal erforderlichen Levothyroxindosis bei Langzeit-Suppressionstests
Authors: Schroth H.-J. , Holle L.-H. , Garth H. , Rink Th.
Published: March 2018

Ziel: Diese Arbeit ermittelt anhand einer größeren Fallzahl eine Formel zur Bestimmung der individuell minimal erforderlichen Levothyroxindosis bei Langzeit-Suppressionstests in Abhängigkeit von Körpergewicht und TSH-Spiegel. Methode: 1239 euthyreote Patienten (TSH >0,30 mU/l), die für mindestens 6 Wochen mit Levothyroxin substituiert wurden, bilden die Grundlage dieser Studie. Die Hormonmenge orientierte sich dabei primär am initial gemessenen TSH-Spiegel. Als Richtgröße für die Dosis diente der empirische Wert TSH × 100. Minimal wurden 50, maximal 150 μg/d verabreicht. Ergebnisse: Bei 900 Patienten (73%) war der TSH-Spiegel unter der laufenden Medikation supprimiez (TSH <0,30 mU/l). Darunter fanden sich 211 Fälle mit einer mittleren TSH-Suppression (TSH zwischen 0,10 und 0,20 mU/l). Ausgehend von dieser Gruppe errechnet sich nach der Formel f = Levothyroxindosis μg]/(Körpergewicht [kg] × initial gemessenes TSH [mU/l]) ein durchschnittlicher Faktor von 1,57 zur Ermittlung der suppressiven Dosis. Da in der Regel eine vollständige TSH-Suppression (<0,10 mU/l) angestrebt wird, empfiehlt sich für die praktische Durchführung der Faktor 2. Die Berücksichtigung des Körpergewichts ergab, daß bei 313 Patienten die tatsächliche Substitutionsdosis dem Wert 2 × Gewicht × TSH entsprach. Dabei fand sich in 262 Fällen (84%) eine TSH-Suppression, eine Hyperthyreosis factitia wurde nicht beobachtet. Bei Betrachtung der drei Untergruppen dieses Kollektivs, deren Substitutionsdosis 50, 75 bzw. 100 μg Levothyroxin/d betrug, zeigte sich weder ein signifikanter Unterschied des durchschnittlichen Patientengewichts noch des TSH-Spiegels unter Suppressionsbedingungen. Die Korrelation der mittleren initialen TSH-Titer mit der jeweiligen suppressiven Hormondosis belegt allerdings deren Abhängigkeit vom thyreotropen Regelkreis. Schlußfolgerung: Die minimale suppressive Levothyroxindosis hängt nicht nur vom Körpergewicht, sondern auch von der TSH-Sekretion ab. Sie kann durch die Formel 2 × Körpergewicht × basales TSH (minimal 50, maximal 150 μg/d) ermittelt werden.
Der Röntgenthorax: Routineindikation in der Nachsorge des differenzierten Schilddrüsenkarzinoms?
Authors: Beese M. , Mester J. , Brumma K. , Beyer W. , Clausen M. , Lorenzen J.
Published: March 2018

Ziel: Anhand einer retrospektiven Untersuchung wurde überprüft, inwieweit der routinemäßige Einsatz des Röntgenthorax auch bei Low-risk-Patienten trotz der hohen Sensitivität des Tumormarkers Thyreoglobulin sinnvoll ist. Methode: Es wurden die Krankengeschichten von 609 Patienten mit einem differenzierten Schilddrüsenkarzinom ausgewertet. Bei 50 Patienten wurde eine pulmonale Metastasierung diagnostiziert. Der Thyreoglobulinwert zum Zeitpunkt der Diagnosestellung der pulmonalen Metastasierung wurde mit dem Befund des Röntgenthorax und der vorhandenen weiteren Diagnostik, wie der lod-131-Ganzkörperszintigraphie und CT des Thorax, soweit vorhanden, verglichen. Ergebnisse: Die gefundene Sensitivität des Röntgenthorax im Nachweis von Lungenmetastasen lag mit 52% unterhalb der Sensitivität der 131 -lod-Ganzkörperszintigraphie (64%), der Thorax-CT (82%) und der Sensitivität des Thyreoglobulins unter Suppressionsbedingungen (86%). Bei Patienten mit papillärem Schilddrüsenkarzinom der Tumorstadien I und II entwickelte nur ein Patient im Verlauf eine Lungenmetastasierung. Der Nachweis von Lungenfiliae nur mit Hilfe des Röntgenthorax bei einem Thyreoglobulinwert unter der Nachweisgrenze ist in einer solchen Low-risk-Gruppe sehr selten (berechnete Wahrscheinlichkeit: 1:4000) und mit erheblichen Kosten verbunden. Schlußfolgerung: Der routinemäßige, lebenslange Einsatz des Röntgenthorax ohne Rezidivverdacht (z. B. Thyreoglobulin positiv) ist für Low-risk-Patienten zu überdenken.
Lateral Tibial Head Buttress Plate: Use in a Pathological Femoral Fracture Secondary to a Bone Cyst in a Dog
Authors: VanEnkevort B. , Dueland R. T.
Published: March 2018

A ten-month-old neutered Siberian Husky dog sustained a long oblique diaphyseal right femoral fracture which extended into and was secondary to a large metaphyseal bone cyst. The cyst was curetted and bone grafted. To attain adequate fracture and cyst stabilization, an AO/ASIF left tibial head buttress plate was used. Due to the unique configuration and curvature of the plate, three of 11 screws were placed in unaffected epiphyseal bone. This contributed to good frictional apposition of the plate to the bone with resultant excellent fracture stability. Twenty-six weeks after the operation the fracture and cyst had healed and the dog had full function of the limb. The lateral tibial head buttress plate should be considered for use in supracondylar femoral fractures, in large dogs, because of ease of application, good conformity to the distal curvature of the femur, plate stiffness and the resultant stability.

A human tibial plate was used to stabilize a difficult femoral fracture which occurred secondary to a bone cyst. The unique dimensions and shape of the plate facilitated excellent conformity of the plate to the bone and enabled adequate screw fixation in the epiphysis distal to the grafted metaphyseal cyst defect. The fracture and cyst were healed at 26 weeks with excellent limb function.
Surgical Treatment of an Aneurysmal Bone Cyst in a Dog
Authors: Chambers J. N. , Newell S. M. , Duval J. M.
Published: March 2018

Aneurysmal bone cysts are benign but locally aggressive lytic lesions of bone. Surgical curettage and cancellous bone grafting resulted in complete clinical and partial radiographic resolution of an aneurysmal bone cyst of the distal tibia.
Cystic Bone Lesions in Horses and Humans: A Comparative Review
Authors: McIlwraith C. W. , Auer J. A. , von Rechenberg Brigitte
Published: March 2018

Cases of cystic bone lesions in horses and humans were reviewed in the literature. These lesions are radiolucent areas of bone, recognized as subchondral cystic lesions in the horse (SCL), intra-osseous ganglia (IOG), subchondral bone cysts secondary to osteoarthrosis (OAC), and unicameral bone cysts (UCB) in humans. Their morphology is quite similar, consisting of lesions with a distinct cyst wall, and a cavity filled with fibrous tissue and yellowish mucoid fluid. The lesions are surrounded by sclerotic bone and can be easily diagnosed radiographically. SCL, IOG and OAC occur in the subchondral bone close to the adjacent joint, whereas UCB occur in the metaphysis of long bones. Their aetiology and pathogenesis is still unknown, although primary damage to the subchondral bone, cartilage or local blood supply and growth disturbances are discussed. In this review 703 lesions of SCL in horses, 289 lesions of IOG and 1460 lesions of UCB in humans were compared in their anatomical location and clinical signs. SCL and OAC resembled each other with respect to anatomical location. A correlation of affected bones could not be found for all four groups. Clinical presentation concerning age was most similar for SCL and UCB with both lesions mainly occurring in young individuals. Gender predominance of males was present in SCL, IOG and UCB. Clinical diagnosis was either incidental, or connected with intermittent pain in all lesions except for OAC. Additionally, the lesions were also found in conjunction with degenerative joint disease (SCL, OAC) or pathological fractures (UCB). Cystic bone lesions were either treated conservatively, surgically with curettage alone, curettage in combination with grafting procedures, or intra-lesional application of corticosteroids. SCL and UCB were similar in their biological behaviour concerning their slow response to the therapy and relatively high recurrence rate. None of the cystic bone lesions were comparable, and a common aetiology and pathogenesis could not be found.

In a literature review cases of cystic bone lesions in horses and humans were compared with the goal to find a common aetiology and pathogenesis. Cystic bone lesions occur in horses as subchondral cystic lesions (SCL), and in humans as either intra-osseous ganglia (IOG), subchondral cystic lesions secondary to osteoarthrosis (OAC) or unicameral bone cysts (UCB). IOG and OAC compare with SCL mainly in the anatomical location. IOG and SCL resemble each other in size, clinical signs and histology, whereas UCB and SCL show a similar biological behaviour regarding their therapeutic response and recurrence rate. None of the cystic bone lesions in humans were comparable to the SCL in horses in all aspects. A common aetiology and pathogenesis could not be established.
An In Vitro Biomechanical Investigation of Compression Plating with Cable Cerclage for Repair of Oblique Osteotomies in Foal Femurs
Authors: Wilson D. A. , Carson W. L. , Keegan K. G. , Frankeny Rebecca L.
Published: March 2018

Long oblique diaphyseal osteotomies were created in 14 pairs of femurs from cadaver foals less than six months of age. One bone from each pair was repaired using two dynamic compression plates (DP), and the other was repaired using a dynamic compression plate with cable cerclage (CC). Seven pairs were tested in compression and seven pairs in craniolateral-caudomedial (CrL-CdM) three-point bending.

A difference was not found in mean (± SD) breaking strength in compression between the DP (7257.19 ± 2004.08 N) and CC (7761.41 ± 2552.91 N) techniques. Nor was there a difference in mean stiffness in compression between the DP (2533.83 ± 1777.38 N/mm) and CC (3177.98 ± 1694.70 N/mm) techniques. There was no difference in mean stiffness in three-point bending between the DP (244.60 ± 60.80 N/mm) and CC (195.50 ± 80.90 N/mm) techniques. The mean bending breaking strength and bending moment for the DP technique (2839.36 ± 199.46 N and 124,932.00 ± 8776.38 N mm) was significantly (P = 0.02) greater than the CC technique (1940.39 ± 732.80 N and 85,377.72 ± 32243.34 N mm).

The CC system was inferior to the DP technique in CrL-CdM three-point bending strength and moment, but provided equal bending stiffness and equal compressive strength and stiffness.

The use of compression plating with cable cerclage was compared to double plating for repair of long oblique osteotomies in foal femurs. The repairs were tested in compression and 3-point bending. The compression plate with cable cerclage was inferior to double plating in bending strength and moment, but provided equal compressive strength and stiffness.
Effects of Acceleration on Ground Reaction Forces Collected in Healthy Dogs at a Trot
Authors: Rytz U. , Johnston S. A. , Budsberg S. C.
Published: March 2018

The aim of this study was to assess, whether or not, visual grading of changes in subject acceleration during force plate collection within a fixed, measured velocity range was adequate to control acceleration/deceleration. A second question was, whether or not, visual grading of the trials was adequate to prevent significant changes in ground reaction forces within a controlled velocity range. Eight healthy, non-chondrodysplastic dogs, of varying breeds, were used in the study. Each dog was tested in four different protocols. The order in which the dogs completed the different protocols was determined randomly. During all of the protocols, the dogs trotted across the measured testing area within a velocity range of 1.6 to 1.9 m/s. The protocols varied in the amount of acceleration or deceleration allowed in the testing area and the methods of evaluating the acceleration or deceleration. Significant differences in ground reaction force measurements were found, with variations in the acceleration and deceleration. The majority of changes were found in the craniocaudal axis during acceleration and deceleration. Vertical axis measurements were only altered in the rear limbs. Significant differences were not found in any measurement (except the stance phase duration in the rear limb) between the mechanically controlled minimal acceleration/deceleration variation protocol and the visually controlled acceleration/deceleration variation protocol. While visual observation was unable to consistently differentiate acceleration, or deceleration, changes through the testing area, it was able to eliminate enough variation in ground reaction force measurements so that differences were not found between the mechanically controlled minimal acceleration/ deceleration variation protocol nor the visually controlled acceleration/deceleration variation protocol. These results suggest that either method of collection may be acceptable for data collection depending upon the type of study being performed.

The effects of acceleration variation were examined in dogs undergoing force plate gait analysis. Significant differences in ground reaction force measurements were found, with variations in the acceleration and deceleration. The majority of changes were found in the craniocaudal axis, during acceleration and deceleration. Visual observation was unable to consistently differentiate variations in acceleration through the testing area.
Osteogenesis imperfecta in Three Dogs from a Single Litter
Authors: deHaan J. J. , Peck J. N. , Campbell Bonnie , Ginn Pamela , Phillips Lynette , Suero A. , Chase B. J. , Lazar T.
Published: March 2018

Three American Cream puppies from a litter of six were admitted for evaluation and treatment of lameness caused by multiple pathological fractures. Because of a poor prognosis, all three of the affected dogs were ultimately euthanatized. Based on the histopathological findings of the bones and a collagen analysis from cultured skin fibroblast cells which confirmed the presence of abnormal type I collagen, the presumptive diagnosis was osteogenesis imperfecta. In humans, more than 90% of the cases of osteogenesis imperfecta are caused by defects in type I collagen (11). Osteogenesis imperfecta has rarely been described in animals and none of the previous reports document the disease in more than one dog from a single litter.

Three American Cream puppies from a litter of six developed multiple pathologic features without a history of trauma. A diagnosis of osteogenesis imperfecta was made based on histopathology and results of type I collagen analysis from cultured skin fibroblasts.
Maxillofacial surgery: maxillary osteosynthesis craneomaxillofacial CMS-titanium plates
Authors: Vallés M. A. , Vérez-Fraguela J. L.
Published: March 2018

A maxillary fracture is presented which we classified as Le Fort Type III. Treatment was by the application of two craniomaxillofacial CMS titanium plates placed intrabuccally and paramedially on both sides of the palatal suture.

This technique was used as an alternative to the classical treatment using interdental wires or intermaxillary fixation.

A clinical case was diagnosed with a craniofacial fracture caused from being bitten by another dog. This was successfully treated using CMS titanium plates. Many methods exist for maxillofacial fixation, from the cyanocrylates to interdental wires, etc. The indications for these plates are similar to other methods of fixation. Due to their small mass they are ideal for use in fragile bones with little soft tissue covering.
Force plate analyses before and after surgical treatment of unilateral fragmented coronoid process
Authors: Hazewinkel H. A. W. , van den Brom W. E. , Theyse L. F. H.
Published: March 2018

In this prospective study force plate analysis was used to investigate the locomotor aspects of unilateral fragmented medial coronoid process (FCP) and the effects of surgical treatment in seven dogs. The diagnosis unilateral FCP. was based on clinical and radiological examination of both elbow joints and confirmed during surgery. Radiological screening of the elbow joints was repeated at six months after surgery to determine the osteoarthritis (OA) score and to exclude any bilateral involvement. Force plate analyses were performed at three consecutive intervals: prior to surgery, at six weeks and at six months after surgery. The peak braking force Fymax, peak propulsive force-Fymin, peak vertical force-Fzmax and the corresponding impulses Iymax, Iymin and Iz were determined. The symmetry index SI of these forces and impulses (ratio affected side : contralateral side) in the front limbs was assessed to evaluate the locomotion. The combination of the Sis of Fymin, Fymax, Iymin, Iymax and Iz proved to be more sensitive in determining front limb lameness due to unilateral FCP than the SI of the peak vertical force Fzmax. The SI of Fzmax had returned to within the normal range at six months after surgery for all seven dogs, whereas the other parameters showed persisting abnormalities in two dogs. In this study the improvement after surgical treatment of the SI of both Fymin and Iymin was significant at P<0.05. All of the joints showed progressive radiological signs of OA at six months after surgery.

The effects of unilateral fragmented medial coronoid process on the ground reaction forces of the front limbs and the effects of surgical treatment were evaluated using force plate analysis. Surgical treatment seemed to have a favorable outcome, despite radiological progression of osteoarthritis.
Temporary successful closed reduction of an atlantoaxial luxation in a horse
Authors: Edinger H. , Licka T.
Published: March 2018

An eight year-old Welsh cob gelding (weighing 340 kg) was diagnosed with ventral luxation of the dens axis one day after trauma. Neurological signs included severe ataxia, wide stance and hypalgesia. Under general anaesthesia, closed reduction was achieved by maximum extension of the neck and subsequent manual impact on the ventral aspect of the transverse processes of the axis. A follow-up radiograph confirmed the reduction. Eight days later, re-luxation occurred, and as further attempts at nonsurgical and surgical reduction failed, the horse was euthanatised.
Contribution of periarticular tissue to stabilization of the canine stifle joint after cranial cruciate ligament reconstruction
Authors: Hulse D. A. , Slater M. R. , Hart R. C.
Published: March 2018

Biomechanical analysis of the contribution of extracapsular tissues to the stability of normal and cranial cruciate ligament-deficient stifle joints was done using a five degree of freedom test apparatus which allowed quantification of tibial translation. In joints without periarticular tissue, the intracapsular graft technique used achieved joint stability similar to that of the normal cranial cruciate ligament. Our results indicate that the periarticular tissues did not significantly add to the post-operative stability of the stifle after intracapsular reconstruction.
Comparison of porcine and human lumbar spine flexion mechanics*
Authors: Dumas G. A. , Bednar D. A. , Dickey J. P.
Published: March 2018

Animal models have been proposed as an alternative to human spinal specimens for in vitro mechanical testing due to the limited availability, poor reproducibility, high cost, and potential health risk associated with human specimens. The purpose of this study was to directly compare the flexion biomechanics of porcine and human lumbar spines. We determined the range of motion, laxity zone and the stiffness under pure-moment flexion loading. The porcine and human specimens showed qualitative similarities in mechanical behaviour. However the porcine specimens demonstrated a number of quantitative differences including a less-stiff, more extensive, low-stiffness region around the neutral position and a larger flexion range of motion. The results suggest that the porcine lumbar spine may be a potential model for the human lumbar spine for certain in vitro mechanical tests including comparisons between spinal fixation constructs.
Mechanics of the canine femur with two types of hip replacement stems
Authors: Banks-Sills L. , Eliasy R. , Shahar R.
Published: March 2018

The long-term performance of total hip replacement is of concern to veterinary surgeons. Two of the main complications associated with this procedure are implant loosening and stress shielding. Designs of the femoral stem which will avoid loosening and achieve maximum endurance while reducing stress shielding and periprosthetic bone loss are sought.

In the intact femur the stress is distributed over the entire cross section of the bone. After hip replacement this pattern of stress distribution is altered because of the manner in which the load is transferred from the prosthesis to the bone.

The objective of this study was to examine the stresses that develop in the femur and implant components of two different methods of hip replacement used clinically in dogs. Anatomic, three-dimensional finite element models of the canine femur with a cemented femoral stem and a Zurich cementless stem were constructed. The stresses and displacements were calculated by the finite element analysis method, under physiologic loads that included muscle forces and joint reaction forces. The results were compared to results obtained by a similar analysis of an intact femur.

This study demonstrates that the Zurich cementless method causes less stress shielding in the proximal femoral cortex than does the cemented method. Implant stresses are higher in the Zurich cementless stem, but still within an acceptable range.
Radial carpal bone fracture in 13 dogs
Authors: Mortellaro C. M. , Bertoni G. , Martini F. M. , Cantoni A. M. , Di Giancamillo M. , Vignoli M. , Gnudi G.
Published: March 2018

The authors report 13 dogs with radiocarpal bone fracture. The lesion was bilateral in six cases and unilateral in seven. Clinical and radiographic examination of both the carpal joints was performed. One or two fracture lines, sagittal oblique and dorsal, of the radial carpal bone were detected. CT examination of two radial carpal bones helped in a better visualization of the fracture lines. A dorsal bone fragment of a fractured radial carpal bone was removed in one dog. Histopathology revealed the presence of fibro-connective tissue on the fracture surface of the bone fragment. The fibro-connective tissue did not seem to be the sequel to acute or chronic diseases, nor to any pathological healing process. The cancellous bone of the fragment was normal as was the bulk of the articular cartilage examined. A CT guided biopsy, including the sagittal oblique fracture surface of the radial carpal bone, was also performed. The specimens revealed the presence of immature cancellous bone with diffuse immature cartilage areas. The radial carpal bone has three separate centres of ossification: the primitive radial carpal bone, the central and intermediate carpal bone. The fusion of these centres occurs at 3-4 months of age. Histopathological findings suggest a possible “incomplete fusion” of the centres of ossification rather than a true fracture of the radial carpal bone or alternatively a “fatigue fracture”. A similar condition, involving the distal part of the humerus, was originally reported in several Cocker Spaniel dogs, and more recently in Rottweilers and Labrador Retrievers.
Percutaneous plating of tibial fractures in two dogs
Authors: Hurter K. , Schawalder P. , Schmökel H. G.
Published: March 2018

A trend toward minimally invasive procedures in the treatment of fractures in human patients is apparent in recent publications. Percutaneous plating is one method of fracture fixation, conceived to minimise soft tissue damage and preserve soft tissue and bone vascularity. The use of fewer screws, in longer bridging plates, is also a relatively new technique in the stabilisation of comminuted diaphyseal fractures in human patients. A combination of these techniques was applied in two dogs with comminuted tibial fractures.

The plates were passed subfascially and the screws inserted through skin incisions over the proximal and distal ends of the plate. Follow-up radiographs revealed fracture healing with callus formation after four or five weeks. Percutaneous plating seems to be a useful technique in small animals. Further studies on larger numbers of patients are needed to define the benefits and the limitations of this technique.
Sichere und effektive Therapie mit Sorafenib: Hepatische Funktion und AFP als Outcomefaktoren beim HCC
Authors: Kretzschmar Alexander
Published: March 2018

Auf dem ASCO 2010 wurden neue Studien präsentiert, in denen Sorafenib (Nexavar®) unter unterschiedlichen Aspekten der Therapie des fortgeschrittenen hepatozellulären Karzinoms (HCC) untersucht wurde. Sorafenib war hier bei Patienten mit erhöhten Ausgangswerten der Transaminasen, AFP oder Bilirubin sicher und effektiv. Erfolgversprechende Ergebnisse zeigte Sorafenib auch in Regimen mit lokal-invasiven Verfahren (TACE, SIRT).
Multiples Myelom: Myeloma IX-Studie belegt Überlebensvorteil durch Zoledronat
Authors: Satzger Ulla
Published: March 2018

Zoledronat hat einen direkten antineoplastischen Effekt und kann das Gesamtüberleben von Patienten mit Multiplem Myelom signifikant verlängern. Dies zeigt eine auf dem 46. Annual Meeting der American Society of Clinical Oncology (ASCO) vorgestellte Studie an fast 2000 Patienten. Durch die zusätzliche Gabe von Zoledronat (Zometa®) zur Chemotherapie verbesserte sich das Gesamtüberleben der Patienten mit Multiplem Myelom verglichen mit Clodronat signifikant um durchschnittlich 16%.
30 Jahrestagungen – medizinischer Fortschritt trifft Versorgungsrealität
Authors: Henning Peter
Published: March 2018

Mit jährlich bis zu 55 000 Neuerkrankungen ist Brustkrebs der häufigste bösartige Tumor der Frau. Aktuelle Daten belegen, dass Patientinnen in Brustkrebszentren bessere Heilungs- und Überlebenschancen haben. Die Deutsche Gesellschaft für Senologie (DGS) informierte auf ihrer 30. Jahrestagung vom 1. bis 3. Juli 2010 in Hamburg über neue wissenschaftliche Erkenntnisse und erfolgversprechende Therapien.
Metastasiertes Mammakarzinom: Capecitabin bewährt in der Firstline
Authors: Stürmer Sabine
Published: March 2018

Die Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) hat ihre Empfehlungen zum Einsatz des oralen Zytostatikums Capecitabin (Xeloda®) erweitert.
Strategien zur Prävention invasiver Mykosen: Konsequente Prophylaxe zahlt sich aus
Authors: Limberg Wolfgang
Published: March 2018

Pilzinfektionen sind bei Hochrisiko-Patienten mit Neutropenie schwer zu behandeln und enden oft tödlich. Erprobte Prophylaxe-Strategien nutzen unter anderem Azole, um invasive Mykosen und damit das Sterblichkeitsrisiko zu reduzieren.
Use of the AO veterinary mini ‘T’-plate for stabilisation of distal radius and ulna fractures in toy breed dogs
Authors: Langley Hobbs S. J. , Hamilton M. H.
Published: March 2018

The use of the AO (Arbeitsgemeinschaft für Osteosynthesefragen) veterinary mini ‘T’-plate for stabilisation of distal radius and ulna fractures in toy breed dogs was evaluated in a retrospective study. All of the 14 dogs in the study weighed 3.5 kg or less. The AO mini ‘T’-platea was used as the final means of fixation in all cases. It was used as the primary form of stabilisation in ten dogs, and in four dogs it was used at revision surgery. In all cases the fractures healed. Return to function was graded as excellent in six cases, good in four and fair in two. Two dogs were lost to long-term follow up. It was concluded that the AO veterinary mini ‘T’-plate is a suitable choice of implant for stabilisation of distal radius and ulna fractures in toy breed dogs, especially when the distal fragment is very small.
Comparison of radiographic arthritic changes associated with two variations of tibial plateau leveling osteotomy
Authors: Allen D. A. , Wilson E. R. , Tobias T. A. , Shaiken L. G. , Shiroma J. T. , Biller D. S. , Lehenbauer T. W. , Lineberger J. A.
Published: March 2018

Osteoarthritis (OA) progresses in the canine cranial cruciate ligament (CCL) deficient stifle. Progression of OA is also documented in canine patients after various surgical repair techniques for this injury. We evaluated the radiographic arthritic changes in canine stifle joints that have sustained a CCL injury, and compared radiographic OA scores between Tibial Plateau Leveling Osteotomy (TPLO.)surgery patients receiving a medial parapatellar exploratory arthrotomy for CCL remnant removal versus those receiving a limited caudal medial arthrotomy without removal of the CCL remnants. Medial/ lateral and caudal/cranial stifle radiographs were obtained before surgery, immediately following TPLO surgery and at 7–38 months (mean 20.5) after surgery. Sixty-eight patients (72 stifles) were included in the study. The cases were divided into two groups. The patients in group 1 (n = 49 patients, 51 stifles) had a limited caudal medial arthrotomy, and patients in group 2 (n = 19 patients, 21 stifles) had a medial parapatellar open arthrotomy. A previously described radiographic osteoarthritis scoring system was used to quantify changes in both of the groups. The age, weight, OA scores, initial tibial plateau angle, final tibial plateau angle, and the change in angle were compared between the groups. The results showed that there was significantly less progression of OA in the group that had the limited caudal medial, arthrotomy, versus a medial parapatellar open arthrotomy. There was a significant advancement of the OA scores of patients that had TPLO surgery.
Isometry of potential suture attachment sites for the medial aspect of the tibiotarsal joint
Authors: Roe S. C. , Jaeger G. H.
Published: March 2018

The isometry of the bipartite medial collateral ligament of the tarsus and two methods of stabilization by prosthetic ligament were assessed by measuring the change in distance between the origin and the insertion through full range of joint motion of the ligament and prosthetic ligaments. The single suture technique was isometric when the distal site was located at the centre of the trochlea of the talus. This site can only be used when the medial malleolus, which overlies the talus, is missing or removed. Whilst some length changes occur with hock motion, the double suture technique may be advocated in instances where the medial malleolus is present.
Computerized tomography compared with radiography in the diagnosis of lateral trochlear ridge talar osteochondritis dissecans in dogs
Authors: van Ryssen B. , van Bree H. , Gielen I.
Published: March 2018

In this retrospective study, we compared the value of radiographic and computerized tomographic (CT) imaging for the diagnosis of lateral trochlear ridge talar osteochondritis dissecans (LTRT-OCD) in 11 tarsocrural joints. The flexed dorsoplantar skyline and the plantarolateral-dorsomedial projections were the most reliable for radiographic detection of OCD fragments (in 7 of the 11 joints). Overall, radiography detected OCD fragments in 8 of 11 joints. By contrast, the OCD fragments could be visualized and exactly localized by CT in all 11 joints. Computerized tomography allowed the talar ridges to be inspected without superimposition of any bony structures. This information may be very useful when minimal invasive techniques are used to treat LTRT-OCD lesions. The findings of this study suggest that CT is superior to radiography for making a diagnosis of LTRT-OCD in the dog.
The ComPact UniLock 2.0/2.4 system and its clinical application in small animal orthopedics
Authors: Voss K. , Montavon P. M. , Keller M. A.
Published: March 2018

This study describes the titanium ComPact UniLock 2.0/2.4™ locking plate system (Stratec Medical, Oberdorf, Switzerland) and reports its application in nine selected clinical cases. The system was found useful for a variety of indications. Three categories of clinical applications are illustrated. They include (a) long bone fractures, (b) cervical spinal fractures and instabilities and (c) joint instabilities and luxations. A brief introduction to the system has already been published (1).