Prognostic factors in metastatic renal cell carcinoma: metastasectomy as independent prognostic variable.

Prognostic and predictive factors in patients with metastatic renal cell carcinoma (MRCC) have been evaluated from untreated patients or patients on several different treatment approaches. The aim of this analysis was to define prognostic and predictive factors in patients treated uniformly with a low-dose outpatient cytokine combination. The relationship between patient-, tumour-, and treatment-related factors was analysed in 99 patients with MRCC. These features were first examined in univariate analyses, then a stepwise modelling approach based on Cox regression was used to form a multivariate model. Nuclear grade, metastasectomy--even incomplete--C-reactive protein and lactate dehydrogenase were identified as independent prognostic factors for survival. Patients assigned to three different risk groups had statistically significant survival differences (30, 22 and 6 months, respectively). A total of 43.4% had undergone metastasectomy, mostly incomplete. Risk group affiliation was correlated with response to treatment. Our findings strongly suggest the consideration of metastasectomy in the management of patients with metastatic renal cell cancer undergoing either immunotherapy or targeted treatment.

[Prevention of heterotopic ossification after THA with indomethacin: analysis of risk factors]. / Ossifikationsprophylaxe nach Hüft-TEP mit Indomethacin: Analyse von Risikofaktoren.

AIM: Several risk factors are associated with heterotopic bone formation following total hip replacement. All these risk factors were defined in cohorts without any treatment against postoperative ectopic bone. The aim of this prospective study was to reveal risk factors for the development of postoperative ossifications in patients who underwent a 7-day course of indomethacin therapy. METHODS: 211 consecutive patients with 217 cementless total hip arthroplasties were included. Patients were given 100 mg indomethacin daily in a 7-day course. RESULTS: Grade 2 or 3 ossifications were observed in 13 (5%) of the male and 3 (2%) of the female Individuals postoperatively (p = 0.0043; odds ratio = 0.45). Older individuals (p = 0.0021; odds ratio = 1.03) as well as patients with primary osteoarthritis (p = 0.0307; odds ratio = 0.28) also showed a higher risk for developing ectopic bone formations. CONCLUSION: With a 7-day course of indomethacin after total hip arthroplasty, male and elderly individuals, as well as patients with primary osteoarthritis, are considered to be at high risk to develop heterotopic ossifications postoperatively. Indomethacin reduces the incidence of postoperative ectopic ossifications, but not the patient's risk.

Rotator cuff tears in asymptomatic individuals: a clinical and ultrasonographic screening study.

OBJECTIVE: To determine the prevalence and clinical impact of rotator cuff tears in asymptomatic volunteers. MATERIALS AND METHODS: Sonographic examinations of the shoulder of 212 asymptomatic individuals between 18 and 85 years old were performed by a single experienced operator. The prevalence and location of complete rotator cuff tears were evaluated. The clinical assessment was based on the Constant Score. Magnetic resonance imaging (MRI) of the shoulder was obtained in those patients where US showed rotator cuff pathology. RESULTS: Ultrasound showed a complete rupture of the supraspinatus tendon in 6% of 212 patients from 56 to 83 years of age (mean: 67 years). MRI confirmed a complete rupture of the supraspinatus tendon in 90%. All patients reported no functional deficits, although strength was significantly lower in the patient group with complete supraspinatus tendon tear (P < 0.01). CONCLUSION: There is a higher prevalence in older individuals of rotator cuff tendon tears that cause no pain or decrease in activities of daily living.

[Risk factors for dislocation of a cementless total hip endoprosthesis--a statistical analysis]. / Risikofaktoren für die Luxation einer zementfreien Hüfttotalendoprothese--Eine statistische Analyse.

AIM: This retrospective study aimed at the statistical identification of risk factors for dislocation for a certain cementless hip endoprothesis. MATERIAL AND METHOD: At our department 2605 primary total hip arthroplasties were performed between 1987 and 1997. In 40 patients (1.5%) a dislocation occurred. These patients were compared with a control group matched in number. RESULTS: No difference was found in both groups with respect to age, height, weight, body-mass index, and diagnosis. A tendency was found that more males were involved in the dislocation group. There were more previous operations found in this group (p = 0.005). Also significant was the fact, that patients in the dislocation group more often had epidural anaesthesia (p = 0.02), more often the implantation of the smaller 28-mm head (vs. 32 mm) (p = 0.02), and a higher inclination angle of the acetabular component (p = 0.02). No difference was found in terms of the surgeons experience, the postoperative leg length, femoral offset, medialisation, cranialisation and antetorsion of the acetabular component. CONCLUSION: Dislocation after total hip arthroplasty is a multifactorial complication. With the use of the Alloclassic/Zweymüller total hip endoprothesis, a higher risk for dislocation was found for patients with previous hip surgery, the use of the smaller endoprosthesis head, a high acetabular inclination angle, and in the use of epidural anaesthesia.