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INTRODUCTION: Global discussions regarding the treatment of Legg-Calvé-Perthes disease (LCPD) are still controversial. The aim of this study was to characterize the worldwide regional differences in nonoperative and operative treatment for LCPD. MATERIALS AND METHODS: Based on a comprehensive literature search, 123 studies describing the results of nonoperative and operative treatment for LCPD were included. Overall, disease and outcome parameters of 6,968 hips were recorded and compared among the continents-Europe, North America, Asia, Africa, South America, and Australia. RESULTS: Our results showed that the continents differed regarding initial disease progression and therapeutic decision-making, but the final outcome was comparable. The reported proportion of affected hips with mild presentation tended to be higher in Europe, North America, and Africa, whereas disease progression was more severe in Asia, Australia, and South America. Nonoperative treatment was reported more frequently in Europe and North America, while operative management was more common in the rest of the world. Femoral osteotomy was performed more frequently than pelvic osteotomy worldwide, but pelvic osteotomy was comparably more common in North America, Australia, and South America. CONCLUSIONS: The continents differed in terms of therapies for LCPD, while the final outcome was similar. Studies with greater evidence and larger sample size are needed to evaluate the effect of therapeutic measures on LCPD outcome. LEVEL OF EVIDENCE: III (systematic review of level III studies).
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Doença de Legg-Calve-Perthes/terapia , Progressão da Doença , Fêmur/cirurgia , Humanos , Osteotomia , Pelve/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Scarf osteotomy is a frequently used technique to correct moderate to severe hallux valgus deformities. Recurrence of a deformity is a commonly reported complication after surgery. The aim of our study was to evaluate the impact of preoperative deformity on radiological outcome in terms of postoperative loss of correction after scarf osteotomy. METHODS: 102 patients, in which a hallux valgus deformity was corrected with an isolated scarf osteotomy were included. Weightbearing radiographs were analyzed preoperatively, postoperatively, after 6 weeks and after three months (mean 10.9 months SD 17.2 months). The following radiological parameters were used for analysis: the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), position of the sesamoids, first metatarsal length, and first metatarsophalangeal joint congruity. RESULTS: Significant correction of IMA, HVA, DMAA, sesamoid position and joint congruity was achieved (p < 0.001). The IMA improved from 15.8 ± 2.3 to 4.3 ± 2.8°, the HVA from 32.6 ± 6.8 to 9.1 ± 7.2, and the DMAA from 11.4 ± 6.9 to 8.4 ± 5.2°, respectively. In contrast to DMAA, throughout followup we could detect loss of correction for HVA and for IMA amounting 6.3° ± 5.8 and 3.8° ± 2.8 respectively. Loss of HVA correction revealed a significant correlation with preoperative DMAA, but not with the other preoperative radiological parameters. CONCLUSIONS: Preoperative deformity does not correlate with postoperative loss of correction after scarf osteotomy, except DMAA. CLINICAL RELEVANCE: Our results may be helpful in counseling patients regarding recurrence of hallux valgus deformity after scarf osteotomy. LEVEL OF EVIDENCE: Therapeutic, Level IV, retrospective case series.
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Hallux Valgus/cirurgia , Hallux/diagnóstico por imagem , Articulação Metatarsofalângica/diagnóstico por imagem , Osteotomia/métodos , Radiografia/métodos , Feminino , Hallux Valgus/diagnóstico , Hallux Valgus/fisiopatologia , Humanos , Masculino , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Articulação Metatarsofalângica/cirurgia , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Suporte de CargaRESUMO
PURPOSE: Occult intra-operative periprosthetic acetabular fracture is a seldom-reported complication of primary total hip arthroplasty (THA). It may potentially be associated with cup instability and implant loosening. The present study aimed to investigate clinical consequences of this complication. METHODS: Between 2003 and 2012, a total of 3390 cementless total hip arthroplasties (THA) were performed at our institution. Their medical histories were retrospectively reviewed to identify all patients who received a thin-layer computer tomography (CT) scan of the pelvis including the acetabulum within the first 30 post-operative days. They were evaluated and classified by two radiologists independently with respect to the presence of recent acetabular fractures. All cases with acetabular and periacetabular fractures were included in this study. Electronic medical records were reviewed to assess implant revision. Cup stability was measured with EBRA (Einzel-Bild-Röntgen-Analyse) from plain X-rays. RESULTS: Periprosthetic fractures of the acetabulum were identified in 58 (50.4%) of 115 selected patients. Fractures close to but not including the acetabulum were identified in 45% (n = 26/58) of the patients, at the superolateral wall in 17% (n = 10/58), at the anterior wall of the acetabulum in 16% (n = 9/58) and in 10% (n = 6/58) each at the medial wall, and at the posterior wall respectively. One out of these 58 fractures could not be classified. Three of a total of six occult medial wall fractures had to be revised, and another two showed a high implant migration. The highest cup migration values however were found after fractures of the superolateral wall. Incomplete column fractures did not influence implant survival. CONCLUSION: Central wall acetabular fractures, although unrecognized intra- and post-operatively may impair implant survival after THA.
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Acetábulo/lesões , Artroplastia de Quadril/efeitos adversos , Fraturas Ósseas/etiologia , Prótese de Quadril/efeitos adversos , Fraturas Periprotéticas/etiologia , Falha de Prótese/etiologia , Acetábulo/cirurgia , Idoso , Artroplastia de Quadril/instrumentação , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Fechadas/diagnóstico por imagem , Fraturas Fechadas/etiologia , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: The correlation between tibial tuberosity-trochlear groove distance (TT-TG) and joint size, taking into account several different parameters of knee joint size as well as lower limb dimensions, is evaluated in order to assess whether TT-TG indices should be used in instead of absolute TT-TG values. METHODS: This study comprised a retrospective analysis of knee CT scans, including 36 cases with patellofemoral instability (PFI) and 30 controls. Besides TT-TG, five measures of knee joint size were evaluated in axial CT slices: medio-lateral femur width, antero-posterior lateral condylar height, medio-lateral width of the tibia, width of the patella and the proximal-distal joint size (TT-TE). Furthermore, the length of the femur, the tibia and the total leg length were measured in the CT scanogram. Correlation analysis of TT-TG and the other parameters was done by calculating the Spearman correlation coefficient. RESULTS: In the PFI group lateral condylar height (r = 0.370), tibia width (r = 0.406) and patella width (r = 0.366) showed significant moderate correlations (p < 0.03) with TT-TG. Furthermore, we found a significant correlation between TT-TG and tibia length (r = 0.371) and total leg length (r = 381). The control group showed no significant correlation between TT-TG and knee joint size or between TT-TG and measures of lower limb length. CONCLUSIONS: Tibial tuberosity-trochlear groove distance correlates with several parameters of knee joint size and leg length in patients with patellofemoral instability. Application of indices determining TT-TG as a ratio of joint size could be helpful in establishing the indication for medial transfer of the tibial tuberosity in patients with PFI. LEVEL OF EVIDENCE: Level III.
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Instabilidade Articular/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Extremidade Inferior/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
PURPOSE: To assess driving ability (brake response time [BRT]) with commonly used knee braces. METHODS: Sixty-four healthy participants (32 women and 32 men) participated in our study. BRT was assessed using a custom-made driving simulator. We assessed BRT for 5 different commonly used knee braces (right leg) used in 9 different settings: without a knee brace (control group); with a typical postoperative knee brace with adjustable range of motion (ROM) and the settings of 0° to 30°, 0° to 60°, 0° to 90°, and 20° to 90° (extension and flexion); and with an unloading knee brace for moderate to severe unicompartmental osteoarthritis, an orthosis for ligament instabilities, a knee brace for patellofemoral disorders, and an elastic knee bandage. RESULTS: The 64 participants (mean age, 33.5 years) showed significantly impaired BRT with the typical postoperative brace set at an ROM of 0° to 30° (673 milliseconds, P < .001), ROM of 0° to 60° (629 milliseconds, P < .001), ROM of 0° to 90° (607 milliseconds, P = .001), and ROM of 20° to 90° (602 milliseconds, P = .005) compared with the control group. However, no such impaired BRT was found for any other investigated knee brace. CONCLUSIONS: Right-sided ROM-restricting knee braces involve significant impairment of BRT in healthy participants. No such prolonged BRT was found for a patellofemoral realignment brace, a ligament brace, a valgus/osteoarthritis brace, or an elastic knee bandage. However, our findings should be viewed in light of the limitations of the study, which are (1) the lack of a defined decrease in BRT that could lead to an accident and (2) uncertainty of whether the statistical differences are also clinically important. LEVEL OF EVIDENCE: Level II, lesser-quality randomized controlled trial.
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Condução de Veículo , Braquetes , Articulação do Joelho/fisiopatologia , Tempo de Reação , Adulto , Simulação por Computador , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Amplitude de Movimento ArticularRESUMO
PURPOSE: Prior studies have reported improved gait performance and kinematics after total ankle arthroplasty (TAR) compared to ankle arthrodesis (AAD). Given these findings, AAD has been primarily considered as a salvage procedure that may lead to adjacent joint degeneration. METHODS: A total of 101 TAR and 40 screw arthrodeses were enrolled in a retrospective study with a prospectively designed follow-up examination that included gait analysis and outcome assessment with the AOFAS hindfoot score and FAOS questionnaire. RESULTS: Significant asymmetry in gait and reduced range of motion compared to normal remained after both procedures. Subjective outcome improved after both procedures, and pain was significantly better after TAR. Limited functional gains after TAR and joint degeneration to the same degree after both procedures was seen in the mid-term. Hindfoot fusion seemed to have a greater impact on postoperative function than ankle arthrodesis. CONCLUSION: Considering only minor functional gains of TAR compared to AAD the implantation of current TAR designs in large patient series may be questioned.
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Articulação do Tornozelo/fisiologia , Artrodese/métodos , Artroplastia de Substituição do Tornozelo/métodos , Osteoartrite/cirurgia , Amplitude de Movimento Articular/fisiologia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Fenômenos Biomecânicos/fisiologia , Seguimentos , Marcha/fisiologia , Humanos , Avaliação de Resultados da Assistência ao Paciente , Estudos Prospectivos , Radiografia , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do TratamentoRESUMO
INTRODUCTION: The Chiari pelvic osteotomy (CPO) has been recommended as a salvage procedure to improve head coverage in case of hip joint incongruence in paediatric hip disease. In this study, we aimed to assess the long-term results of CPO for severe Legg-Calvé-Perthes disease (LCPD). METHODS: A total of 39 patients who underwent a CPO at our department between 1995 and 2010 were prospectively followed both radiologically (Stulberg classification) and clinically (Harris Hip Score [HHS], conversion into total hip arthroplasty). In this study, we retrospectively reviewed the cases of 12 hips (12 patients, 3 girls, 8 left hips) treated by CPO for severe LCPD (Catterall grade 3 or 4) with hip joint incongruence. Mean follow-up was 14.0 (range 7.6-21.3) years. RESULTS: Mean age at surgery was 10.2 (range 8.2-17.8) years. Additional femoral osteotomy was performed in 8 patients. A good radiological result (Stulberg I or II) was achieved in 2 patients, a fair result (Stulberg III) in 4 patients, and a poor outcome (Stulberg IV or V) in 6 patients. Mean postoperative HHS averaged 93 (range 65-100) points. An excellent functional outcome (HHS 90-100 points) was achieved in 9 patients. No patient underwent total hip arthroplasty during follow-up. Postoperative limb-length discrepancy was found in 3 patients. CONCLUSIONS: CPO for severe LCPD with hip joint incongruence resulted in good long-term clinical outcome in about â of our patients after a mean of 14 years. Our results suggest that CPO can still be considered as a salvage joint-conserving procedure in this selected group of younger patients.
Assuntos
Artroplastia de Quadril , Doença de Legg-Calve-Perthes , Feminino , Humanos , Criança , Adolescente , Doença de Legg-Calve-Perthes/diagnóstico por imagem , Doença de Legg-Calve-Perthes/cirurgia , Seguimentos , Estudos Retrospectivos , Resultado do Tratamento , Osteotomia/efeitos adversos , Osteotomia/métodosRESUMO
PURPOSE: Subtalar arthroereisis has been described for the treatment of flexible juvenile flatfoot. However, the mechanism responsible for deformity correction has not yet been investigated adequately. The aim of this study was to document the effect of subtalar arthroereisis on the tarsometatarsal bone morphology. METHODS: We retrospectively reviewed the clinical and radiological data of 26 patients (45 feet) with juvenile flexible flatfoot deformity treated by subtalar arthroereisis at our department between 2000 and 2018. Radiological evaluation included angular measurements of tarsometatarsal bone morphology as well as hindfoot and midfoot alignment. Mean radiographic follow-up was 19.4 months (sd 8.8; 12 to 41). RESULTS: A significant change of angular measurements of tarsometatarsal bone morphology was found after subtalar arthroereisis (p < 0.001). While there was an increase of the distal medial cuneiform angle (DMCA) and the medial cuneo-first metatarsal angle on the anteroposterior view, a decrease of the naviculo-medial cuneiform angle and the medial cuneo-first metatarsal angle was seen on the lateral view. Furthermore, we found significant improvements of all hindfoot and midfoot alignment parameters except the lateral tibio-calcaneal angle and the calcaneal pitch angle (p < 0.001). CONCLUSION: Our data support the theory of tarsometatarsal bone remodelling, which may contribute to the effect of subtalar arthroereisis for the treatment of flexible juvenile flatfoot. LEVEL OF EVIDENCE: IV.
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Early migration has reportedly been predictive for later implant failure. Using four different migration patterns, this study aimed to analyse migration behaviour of the two types of implant fixation--cemented and cementless--throughout the process of loosening. Migrational behaviour of 69 revised stems (49 cemented, 20 uncemented) was analysed retrospectively with EBRA-FCA (Einzel-Bild-Röntgen-Analyse, Femoral Component Analysis). Uncemented stems failed after early and late onset migration alike, while late migration was the predominant pattern in cemented stems. Mean prosthetic failure after early migration occurred 5.8 (+/-4.4) years postoperatively due to insufficient primary stability. Initially stable stems with late onset migration were revised after 12.4 (+/-4.5) years. Measurement of early migration was found to be a valuable tool to screen short-term and mid-term failure. In the long run the method's sensitivity decreased. Late onset migration, however, preceded long-term failure by a mean of three years.
Assuntos
Artroplastia de Quadril/instrumentação , Cimentos Ósseos , Análise de Falha de Equipamento , Prótese de Quadril , Falha de Prótese , Idoso , Artroplastia de Quadril/efeitos adversos , Prótese de Quadril/efeitos adversos , Humanos , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Sensibilidade e Especificidade , Fatores de Tempo , Falha de TratamentoRESUMO
BACKGROUND:: Recurrence is relatively common after surgical correction of hallux valgus. Multiple factors are discussed that could have an influence in the loss of correction. The aim of this study was to determine preoperative radiological factors with an influence on loss of correction after distal chevron osteotomy for hallux valgus. METHODS:: Five hundred twenty-four patients who underwent the correction of a hallux valgus by means of distal chevron osteotomy at our institution between 2002 and 2012 were included. We assessed weightbearing x-rays at 4 time points: preoperatively, postoperatively, and after 6 weeks and 3 months. We investigated the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), joint congruity, and the position of the sesamoids. RESULTS:: At all points of the survey, significant correction of the IMA and HVA was detected. The IMA improved from 12.9 (± 2.8) to 4.5 (± 2.4) degrees and the HVA from 27.5 (± 6.9) to 9.1 (± 5.3) degrees. Loss of correction was found in both HVA and IMA during follow-up with a mean of 4.5 and 1.9 degrees, respectively. Loss of correction showed a linear correlation with preoperative IMA and HVA, and a correlation between preoperative DMAA and sesamoid position. CONCLUSION:: The chevron osteotomy showed significant correction for HVA, IMA, and DMAA. Preoperative deformity, in terms of IMA, HVA, DMAA, and sesamoid position, correlated with the loss of correction and could be assessed preoperatively for HVA and IMA. Loss of correction at 3 months persisted during the follow-up period. LEVEL OF EVIDENCE:: Level IV, retrospective case series.
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Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Osteotomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Recidiva , Estudos RetrospectivosRESUMO
BACKGROUND: Hallux valgus surgery is associated with significant early postoperative pain. The aim of this study was to investigate the use of continuous wound infiltration (CWI) with ropivacaine for pain management after hallux valgus surgery. METHODS: In this prospective, randomized, double-blind, and placebo-controlled single-center trial, 50 patients undergoing distal metatarsal osteotomy for idiopathic hallux valgus were allocated to CWI with ropivacaine 2 mg/mL at a rate of 2 mL/h or placebo for 24 hours postoperatively. Average and peak pain levels on the verbal numeric rating scale (NRS; 1-10) during the first 48 hours after surgery were recorded as primary outcome parameters. Secondary outcome parameters included consumption of narcotics, clinical outcome, incidence of postoperative complications, and patient satisfaction. RESULTS: No significant difference in mean ( P = .596) and peak ( P = .353) postoperative pain level was found for CWI with either ropivacaine (mean NRS 1.9 ± 0.8; peak NRS 3.5 ± 2.0) or placebo (mean NRS 2.0 ± 0.7; peak NRS 3.9 ± 1.7) during the early postoperative course. Furthermore, no significant difference between both groups was detected regarding narcotic consumption ( P = .354) and all other secondary outcome parameters. Two severe complications (local dysesthesia with CWI, catheter accidentally fixed by a suture) and 5 catheter dislocations were observed. CONCLUSION: CWI with ropivacaine 2 mg/mL at a rate of 2 mL/h for 24 hours after hallux valgus surgery did not reduce postoperative pain level in an inpatient setting. LEVEL OF EVIDENCE: Level I, prospective randomized trial.
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Amidas/farmacocinética , Joanete/complicações , Hallux Valgus/cirurgia , Osteotomia/efeitos adversos , Dor Pós-Operatória/etiologia , Amidas/química , Amidas/farmacologia , Método Duplo-Cego , Humanos , Estudos Prospectivos , RopivacainaRESUMO
The prosthetic restoration and dental long-term care of two oligodont male cousins suffering from X-linked hypohidrotic ectodermal dysplasia is described in two case histories. The first patient was three times supplied with removable dentures at an age from 5 to 12 years, and the second patient was restored twice by tooth- and implant-supported dentures within an observation period of 10 years. In both patients, implants were placed in the growing jaw (both arches) in order to enhance denture retention by single attachments and/or a palatinal bar. In one patient, loss of one maxillary implant occurred 3 years after implant exposure and 2 years after the provision of the implant-supported denture. In the second patient, after completion of growth and preceding bone augmentation, further implants facilitated an improved removable maxillary restoration. In both patients, an orthodontic alignment and reshaping of the conical anterior teeth by means of resin or full-ceramic crowns was applied to improve the esthetic appearance. Patients with HED require a consistent lifelong attendance comprised of oral hygiene, denture maintenance, and refitting. In oligo-/anodont children, the placement of implants in selected regions may be useful for the enhancement of denture retention. However, due to poor bone quality and volume, implant failure may occur.
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Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Displasia Ectodérmica/reabilitação , Criança , Humanos , MasculinoRESUMO
In multiple myeloma (MM), neoplastic plasma cells accumulate in the bone marrow where their survival, proliferation, and apoptosis are controlled at multiple levels by interaction with the bone marrow microenvironment. Myeloma cells actively control these interactions by activating stromal and endothelial cells for production of survival factors, such as interleukin-6, and suppressing other cell types such as erythroblasts, normal B cell progenitors, and T-cells. In the present study, we identified primary osteoblasts as additional potential targets for myeloma cell-mediated suppression which was partly dependent on the death receptor ligand TRAIL. Besides killing of osteoblasts, myeloma cell lines sensitized osteoblasts to cell death mediated by recombinant TRAIL, whereas primary osteoblasts protected myeloma cells from TRAIL-mediated apoptosis that was mediated by osteoprotegerin (OPG). Besides increase of osteoclastogenesis and osteoclast activity, suppression of bone-forming cells by myeloma cells might contribute to bone loss in MM patients. In addition, clinical development of recombinant TRAIL as anti-myeloma therapy should include evaluation of potential side effects on viability of normal bone cells.
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Proteínas Reguladoras de Apoptose/metabolismo , Apoptose/fisiologia , Glicoproteínas de Membrana/metabolismo , Mieloma Múltiplo/metabolismo , Osteoblastos/citologia , Osteoblastos/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Células da Medula Óssea , Células Cultivadas , Humanos , Ligante Indutor de Apoptose Relacionado a TNFRESUMO
Both gastrocnemius recession and Achilles tendon lengthening lead to scarring in the calf and have high reported recurrence rates when performed under the age of 8 years. Triceps surae lengthening by external fixation seemed to be a valuable alternative. Twelve calf lengthenings have been performed with an Ilizarov device with a mean correction of 27 degrees. No calcaneal gait was observed, but there was a slow continuous loss of dorsiflexion over the observation period. The Ilizarov technique has a higher recurrence rate than most operative procedures for calf lengthening, but carries virtually no risk in producing calcaneus. The technique cannot be recommended for routine clinical use and may only be an alternative for selected cases.
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Pé Equino/cirurgia , Fixadores Externos , Técnica de Ilizarov , Adolescente , Adulto , Paralisia Cerebral/complicações , Criança , Pré-Escolar , Pé Equino/etiologia , Feminino , Humanos , Masculino , RecidivaRESUMO
BACKGROUND: The aim of this study is to assess patients' driving ability when wearing surgical shoes following right-sided first metatarsal osteotomy. METHODS: From August 2013 to August 2015, 42 consecutive patients (mean age 54.5 years) with right-sided hallux valgus deformity underwent first metatarsal osteotomy. Patients were tested for brake response time (BRT) 1 day preoperatively (control run) and at 2 and 6 weeks postoperatively. Two different types of foot orthosis were investigated. BRT was assessed using a custom-made driving simulator. RESULTS: Preoperative BRT was 712 msec (standard deviation (SD), 221 msec). BRT was significantly slower at all tested postoperative times than preoperatively (p < 0.001). The patients showed significant impaired brake response time when wearing surgical shoes. Mean global American Orthopaedic Foot and Ankle Society (AOFAS) outcome score and AOFAS pain and alignment subscores increased postoperatively (p < 0.001). CONCLUSIONS: From our findings, we recommend driving abstinence for a minimum of 6 weeks postoperatively when using a surgical shoe after bunionectomy. However, patients should have sufficient recovery, exercise, and training before resuming driving a car, because safety is always a priority. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02354066.
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Condução de Veículo/psicologia , Órtoses do Pé , Hallux Valgus/cirurgia , Ossos do Metatarso/cirurgia , Osteotomia/reabilitação , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Período Pós-Operatório , Estudos Prospectivos , Tempo de Reação , Recuperação de Função Fisiológica , Sapatos , Adulto JovemRESUMO
BACKGROUND: The purpose of this study was to investigate the radiological and surgical correlation between preoperative magnetic resonance images (MRI) and the intraoperative findings in patients with acquired adult flatfoot. RESULTS: The overall radiological-surgical correlation between preoperative MRI and the intraoperative findings for posterior tibial tendon insufficiency was only slight to fair in our patient's series. Comparing the most commonly used posterior tibial tendon classification systems, the classification of Rosenberg et al. and Kong et al. showed higher interobserver agreement than our modified classification system and the classification system of Conti et al. CONCLUSION: Further prospective studies are needed to evaluate the importance of preoperative MRI before surgical repair of posterior tibial tendon dysfunction.
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BACKGROUND: Multiple myeloma is an incurable plasma cell malignancy that is mostly restricted to the bone marrow. Cancer-induced dysfunction of cytotoxic T cells at the tumor site may be responsible for immune evasion and therapeutical failure of immunotherapies. Therefore, enhanced knowledge about the actual status of T cells in myeloma bone marrow is urgently needed. Here, we assessed the expression of inhibitory molecules PD-1, CTLA-4, 2B4, CD160, senescence marker CD57, and CD28 on T cells of naive and treated myeloma patients in the bone marrow and peripheral blood and collected data on T cell subset distribution in both compartments. In addition, T cell function concerning proliferation and expression of T-bet, IL-2, IFNγ, and CD107a was investigated after in vitro stimulation by CD3/CD28. Finally, data was compared to healthy, age-matched donor T cells from both compartments. METHODS: Multicolor flow cytometry was utilized for the analyses of surface molecules, intracellular staining of cytokines was also performed by flow cytometry, and proliferation was assessed by 3H-thymidine incorporation. Statistical analyses were performed utilizing unpaired T test and Mann-Whitney U test. RESULTS: We observed enhanced T cell exhaustion and senescence especially at the tumor site. CD8+ T cells expressed several molecules associated with T cell exhaustion (PD-1, CTLA-4, 2B4, CD160) and T cell senescence (CD57, lack of CD28). This phenotype was associated with lower proliferative capacity and impaired function. Despite a high expression of the transcription factor T-bet, CD8+ T cells from the tumor site failed to produce IFNγ after CD3/CD28 in vitro restimulation and displayed a reduced ability to degranulate in response to T cell stimuli. Notably, the percentage of senescent CD57+CD28- CD8+ T cells was significantly lower in treated myeloma patients when compared to untreated patients. CONCLUSIONS: T cells from the bone marrow of myeloma patients were more severely impaired than peripheral T cells. While our data suggest that terminally differentiated cells are preferentially deleted by therapy, immune-checkpoint molecules were still present on T cells supporting the potential of checkpoint inhibitors to reactivate T cells in myeloma patients in combination therapies. However, additional avenues to restore anti-myeloma T cell responses are urgently needed.
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Mieloma Múltiplo/patologia , Idoso , Células Sanguíneas , Células da Medula Óssea , Linfócitos T CD8-Positivos/patologia , Estudos de Casos e Controles , Proliferação de Células , Senescência Celular , Feminino , Humanos , Imunofenotipagem , Ativação Linfocitária , Masculino , Pessoa de Meia-Idade , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/patologia , Linfócitos T Citotóxicos/patologiaRESUMO
The bone marrow microenvironment plays a decisive role in multiple myeloma progression and drug resistance. Chemokines are soluble mediators of cell migration, proliferation and survival and essentially modulate tumor progression and drug resistance. Here we investigated bone marrow-derived chemokines of naive and therapy-refractory myeloma patients and discovered that high levels of the chemokine CCL27, known so far for its role in skin inflammatory processes, correlated with worse overall survival of the patients. In addition, chemokine levels were significantly higher in samples from patients who became refractory to bortezomib at first line treatment compared to resistance at later treatment lines.In vitro as well as in an in vivo model we could show that CCL27 triggers bortezomib-resistance of myeloma cells. This effect was strictly dependent on the expression of the respective receptor, CCR10, on stroma cells and involved the modulation of IL-10 expression, activation of myeloma survival pathways, and modulation of proteasomal activity. Drug resistance could be totally reversed by blocking CCR10 by siRNA as well as blocking IL-10 and its receptor.From our data we suggest that blocking the CCR10/CCL27/IL-10 myeloma-stroma crosstalk is a novel therapeutic target that could be especially relevant in early refractory myeloma patients.
Assuntos
Bortezomib/farmacologia , Quimiocina CCL27/metabolismo , Resistencia a Medicamentos Antineoplásicos , Mieloma Múltiplo/tratamento farmacológico , Complexo de Endopeptidases do Proteassoma/metabolismo , Inibidores de Proteassoma/farmacologia , Receptor Cross-Talk/efeitos dos fármacos , Receptores CCR10/metabolismo , Transdução de Sinais/efeitos dos fármacos , Idoso , Apoptose/efeitos dos fármacos , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Feminino , Humanos , Interleucina-10/genética , Interleucina-10/metabolismo , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/enzimologia , Mieloma Múltiplo/genética , Mieloma Múltiplo/patologia , Interferência de RNA , Receptores CCR10/genética , Receptores de Interleucina-10/genética , Receptores de Interleucina-10/metabolismo , Transfecção , Microambiente Tumoral , Ensaios Antitumorais Modelo de XenoenxertoRESUMO
BACKGROUND: The radius/length (R/L) ratio was developed to evaluate the convexity of the talar dome in idiopathic clubfoot. However, the index has not been tested for its reliability and reproducibility. METHODS: The R/L ratio was determined by three independent observers on the radiographs of 21 adult patients with idiopathic clubfoot and 30 adult subjects with normal feet. The reproducibility and the reliability of the R/L ratio were calculated. RESULTS: For the normal feet the reproducibility and the reliability of the R/L ratio was high (correlation coefficient > 0.87). For the patients with clubfoot, the reliability and reproducibility depended on the severity of talar flattening. For a radius of less than 45 mm the mean intraobserver correlation coefficient was 0.74 (range 0.54 to 0.83) and the mean interobserver correlation coefficient was 0.58 (range 0.49 to 0.75). For a radius of more than 45 mm no statistically significant intraobserver and interobserver correlations were found. CONCLUSION: The current results indicate that the R/L ratio of talar flattening is reliable and reproducible for mild talar deformity but not for severe flattening (radius of more than 45 mm).
Assuntos
Pé Torto Equinovaro/diagnóstico por imagem , Tálus/diagnóstico por imagem , Adulto , Pé Torto Equinovaro/patologia , Humanos , Radiografia , Reprodutibilidade dos Testes , Tálus/patologiaRESUMO
BACKGROUND: The rotational position of the leg substantially influences measurements in ankle radiographs after total ankle replacement (TAR). The aim of our study was to further specify the influence of different projections on radiographic parameters used to assess component position after TAR. METHODS: The effect of varying degrees of internal rotation, flexion, and ab-/adduction on reference lines in anteroposterior and lateral ankle radiographs was investigated in a cadaveric TAR model. Observed variations were then compared with those found in 34 consecutive patients that received a HINTEGRA total ankle prosthesis in our department. RESULTS: A change of rotation of 20° resulted in a variation of measured reference lines of more than 1.3 cm in anteroposterior radiographs and more than 1 cm in lateral radiographs in our experimental setting. Even higher intraindividual changes of up to 1.4 cm were observed in our in vivo series. CONCLUSIONS: The findings suggest that rotational position of the leg highly influences measurements in ankle radiographs after TAR. It further raises the question, if previously described radiographic parameters do provide accurate information for the outcome after TAR in clinical routine as suggested in literature.