Subject(s)
Plastic Surgery Procedures/methods , Postoperative Complications/therapy , Reperfusion Injury/therapy , Surgical Flaps/blood supply , Animals , Antioxidants/therapeutic use , Disease Models, Animal , Fibrinolytic Agents/therapeutic use , Free Radicals/adverse effects , Humans , Mice , Mice, Hairless , Microcirculation/physiology , Muscle, Skeletal/blood supply , Postoperative Complications/physiopathology , Rats , Reactive Oxygen Species/metabolism , Reperfusion Injury/physiopathology , ReplantationABSTRACT
Severe burn induces destabilization of the immune system and the likelihood of multiple organ dysfunction syndrome. Current studies focus on RNA-expression analyses of immune system cells, however, the present methods of analysis are complex, potentially altered by artefacts and therefore not feasible for routine analyses. The new PAXgene Blood RNA System provides "snapshot" analysis of RNA by immediate cell lysis and prevention of RNA-degradation. Using this system the aim of this study was to analyse intracellular cytokine RNA-expression under clinical conditions. Whole blood samples (PAXgene tubes) of nine severely burned patients were drawn at admission and 6, 12, 24, 48 and 72h after trauma during routine treatment. Four healthy individuals served as control. Analysis of RNA-expression of TNF-alpha as pro-inflammatory and IL-10 as anti-inflammatory mediator was performed by RT-PCR. The RNA-expression of TNF-alpha was increased at 72h after burn. The increase occurred mainly in surviving patients. In contrast, RNA-expression of IL-10 was elevated already at 24h and the difference between surviving and deceased patients occurred earlier. We demonstrate for the first time a "snapshot" analysis of cytokine RNA-expression in severely burned patients under routine conditions. The results correspond well to current hypothesis of posttraumatic MODS development.
Subject(s)
Blood Specimen Collection/methods , Burns/blood , Interleukin-10/metabolism , Multiple Organ Failure/blood , RNA, Messenger/metabolism , Tumor Necrosis Factor-alpha/metabolism , Adolescent , Adult , Aged , Analysis of Variance , Burns/complications , Burns/metabolism , Case-Control Studies , Female , Humans , Male , Middle Aged , Multiple Organ Failure/etiology , Multiple Organ Failure/prevention & control , Pilot Projects , Time FactorsABSTRACT
Clinical manifestations of scleroderma at the hand include Raynaud's phenomenon, calcinosis cutis, sclerodactylia and teleangiectasia. With the progression of the disease, cutaneous and joint contractions, acro-osteolysis, necrosis of the finger tips, and even extensive digital ulceration are likely to occur. These painful and often rapidly advancing lesions cause loss of function and disfigurement and, untreated, often lead to mutilation of the affected hand. Only an interdisciplinary management including the hand surgeon, the rheumatologist, and the physiotherapist can guarantee optimal treatment. Drug therapy should be included as well as physical therapy. Both should be made use of before and accompanying surgical treatment. Surgical therapy consists of treatment of the infections, excision of calcinosis, arthrodesis, in particular of the proximal interphalangeal joints, and sympathectomy. Amputation remains a final option, whereas with timely and sufficient treatment, amputations can be avoided and an improvement of function and an alleviation of the symptoms can be achieved. Among the non-operative treatment options, behavioural training, calcium antagonists, prostacyclin derivatives, topical nitrates as well as plexus anesthesia and stellatum blocks have proved to be effective. Recent drug therapies include endothelin-receptor antagonists for the prevention of digital ulceration and phosphodiesterase-V antagonists in treatment of Raynaud's phenomenon and induction of ulcer healing. With reference to several cases seen at our institution, we propose an interdisciplinary treatment concept for acral manifestations of scleroderma.
Subject(s)
Hand Deformities, Acquired/surgery , Hand/surgery , Scleroderma, Systemic/surgery , Aged , Amputation, Surgical , CREST Syndrome/surgery , CREST Syndrome/therapy , Calcinosis/surgery , Female , Fingers/surgery , Follow-Up Studies , Humans , Middle Aged , Necrosis/surgery , Patient Care Team , Raynaud Disease/surgery , Raynaud Disease/therapy , Scleroderma, Systemic/complications , Scleroderma, Systemic/therapy , Sympathectomy , Time FactorsABSTRACT
Liposarcoma is the second most common malignant soft-tissue tumor in adults. Between 1991 and 2002, 167 patients with extremity liposarcomas were treated in our center. Fifty tumors were classified as G1 liposarcomas (30%), 76 as G2 liposarcomas (45.5%), and 41 as G3 liposarcomas (24.5%). In 158 patients, (93.5%) wide tumor excision was performed. Major amputation was necessary in five patients. After a median follow-up of 36 months, 37 patients had developed local recurrence. The 5-year overall survival rate was 79%. The 5-year survival rate in primary tumors was 71/79 (90%, P<0.05) whereas 61/88 of recurrences relapsed locally (69%, P<0.05). Multidisciplinary cooperation in a tumor board is a precondition for adequate treatment.