Tumor cell spheroids as a model for evaluation of metabolic changes after irradiation.

UNLABELLED: Tumor cell spheroids provide a good model to evaluate the relationship between tumor volume and the number of viable cells in the volume with the uptake of metabolic tracers before and after therapy. They represent the only in vitro model that allows the determination of the activity per unit volume, a parameter which is relevant for interpretation of PET studies. The purpose of this study was to evaluate this model with respect to the uptake of 14C-FDG, 3H-methionine and 3H-thymidine with and without exposure to irradiation. METHODS: Spheroids of the human adenocarcinoma cell line SW 707 were incubated in media containing 14C-FDG, 3H-methionine or 3H-thymidine for 1 hr at 1, 4, 8, 24 and 48 hr after exposure to a single radiation dose of 6 Gy together with control spheroids. Tracer uptake after incubation was expressed in cpm/ spheroid, cpm/1000 viable cells and cpm/0.01 mm3. In addition, the proliferative capacity of control and irradiated spheroids was determined using the clonogenic assay. RESULTS: Spheroid uptake of FDG decreased with time after irradiation, while the uptake per 1000 viable cells was increased significantly. The activity per unit volume remained unchanged in comparison to control spheroids. Methionine uptake per spheroid was unchanged after irradiation because of the high increase in uptake per 1000 viable cells. Uptake per unit volume also remained unchanged in comparison to controls. Thymidine uptake per 1000 viable cells did not change after irradiation but showed significant differences in uptake per spheroid and per unit volume compared to controls. The percentage of thymidine incorporated into the TCA-precipitable fraction containing DNA was 50% in controls and decreased to 12% at 24 hr after irradiation. The suppressed clonogenic capacity early after therapy recovered with the increase in thymidine uptake and with the increase in thymidine incorporation into DNA. CONCLUSION: The results show that the activity determined within a certain tumor volume is a balance between the increased tracer uptake by surviving cells after therapy and the lack of tracer uptake by dead cells, which still contribute to the tumor volume. Thus, the resulting unchanged activity per unit volume within the spheroid, as found for FDG and methionine, may not fully reflect therapy-induced metabolic changes in tumors.

[Functional scintigraphy of pulmonary ventilation with 133Xe in juvenile scoliosis (author's transl)]. / Die Funktionsszintigraphie der Lungenventilation mit 133Xe bei juveniler Skoliose.

Twenty children with severe scoliosis underwent spirometry, chest X-ray and 133Xe ventilation studies before surgical correction by the Harrington operation. By means of functional scintigraphy the relative distribution of the functional residual capacity (FRC) and the wash-out curves (3-min-retention without background correction, mean time constant, effectivity index after background correction) were analysed quantitatively. The chest X-ray and the single-breath-phase of the ventilation study remained mostly unchanged, whereas the shifting of the FRC distribution towards the lung of the concave side indicated in all cases a regional ventilation restriction of the convex side. In addition the analysis of the wash-out curves showed a regional impairment of the alveolar ventilation of the convex side which exceeded the shifting of FRC distribution. Even in the cases with normal spirometric values all scintigraphic parameters were slightly pathological, probably due to the decreased lung function caused by the scoliosis. The effectivity index taking into account the respiration frequency, the tidal volume, the FRC and the dead space, was found to be the most accurate and sensitive parameter for the evaluation of regional ventilation impairment.

Relation between peri-operative antithrombin activity and deep vein thrombosis after elective hip replacement surgery.

BACKGROUND: The purpose of the study was to evaluate whether the postoperative depletion or the preoperative antithrombin (AT) activity is related to the occurrence of deep vein thrombosis (DVT) in patients receiving low-molecular-weight heparin for DVT prevention after elective hip replacement surgery. PATIENTS AND METHODS: In 93 patients AT-activity and standard laboratory parameter were determined on the preoperative day and daily for one week after operation. Furthermore, a color-coded compression sonography was performed before and 8-10 days after surgery. The amount of blood loss and blood transfusions was evaluated. Patients were divided into two groups in respect to the occurrence of a postoperative DVT. RESULTS: The overall incidence of DVT was 8.6% (n = 8). Patients with DVT had a significantly lower preoperative AT-activity (80.6 +/- 3.31%) compared to those without DVT (98.1 +/- 1.12%, p < 0.001), however, without being predictive for DVT (positive predictive value 0.71). There was no association between postoperative fall of AT, the lowest postoperative AT activity, blood loss or blood substitution and DVT. CONCLUSIONS: It has to be expected that a small fraction of patients for elective hip surgery present with AT-activity levels possibly being insufficient for a therapeutic effect of low-molecular-weight heparin even preoperatively. Those patients are subject to a significant higher risk of DVT postoperatively.

[Therapeutic efficiency in multisegmental fusions of the lumbar spine]. / Therapeutische Effizienz langstreckiger Fusionen im Bereich der LWS.

AIM: The aim of this study was to evaluate of the efficiency of an internal fixateur used since 1998 in multisegmental spondylodesis of the lumbar spine. METHOD: The prospective study included 105 patients with degenerative changes or instabilities of the lumbar spine, who underwent an anterior and posterior stabilisation of more than two segments. The minimum period of follow-up was more than 6 months. There were several objective scores used for the evaluation of the efficiency (Oswestry score/visual analogue scale [VAS]). In addition, the quality of the new internal implant was assessed concerning the rate of loosening and failure of the implant. This new internal fixateur, produced as a titanium alloy, consists of pedicle screws and longitudinal rods with 5 mm diameter and connection elements. Upon pulling the nut a square stabilised situation is created. Altogether the three-segmental stabilisations predominated (n=77), 23 patients received a four-segmental, four patients a five-segmental stabilisation and one received a stabilisation of six levels, mainly involving the segments L3/4 to L5/S1. Because of severe deformities in 14 cases the pedicle screws were applied by computer-assisted navigation (Navitrak). RESULTS: In 12 patients (11.4%) radiological signs of loosening of the inserted pedicle screws in the vertebra were diagnosed. The radiological analysis resulted in pseudarthrosis of 4 (1.2%) of the 349 amalgamated segments. There were no cases of material failure. The average value of the pain score preoperatively (VAS) was 7.7 (5-10, SA 1.3) and postoperatively 4.6 (1-10, SA 1.8). With regard to the Oswestry disability index the preoperative average value amounted to 51.9% (30-91, SA 11.8) and postoperatively 35% (12-74, SA 11.8). In all 98 (93.3%) patients were satisfied, 7 (6.7%) patients reported a decline of the subjective outcome. CONCLUSION: This system achieved a high degree of patient satisfaction and showed a low rate of pseudarthrosis. Furthermore, it can be inserted for short and long fusions, as well in deformities.

[Results of surgical scoliosis treatment at the Munich Orthopedic Clinic (a study of the years 1973-1977)]. / Ergebnisse der operativen Skoliosebehandlung an der Orthopädischen Klinik München (Eine Studie der Jahre (1973-1977).

We report about a collective of 73 patients which were operated according to Harrington. The patients were followed up for at least two years. In addition we compared two groups of patients each of which had received different bone material. We present our data in comparison to other studies and we discuss advantages and complications of the method applied.

[Results of the surgical therapy of scoliosis]. / Ergebnisse der operativen Skoliosetherapie.

In the years 1981 to 1985 84 patients with scoliosis were mainly treated by the proceeding of Harrington respectively Harrington-Luque. By using the combination Harrington-Luque-wires its getting an evident better result in correction (63%) as by only using the Harrington-instruments (55%).

[Ventral interligamental-intercorporal spondylodesis in spondylolisthesis]. / Die ventrale interligamentäre-interkorporelle Spondylodese bei der Spondylolisthesis.

From November 1982 to March 1986 ventral interligamental intercorporal spondylodesis was accomplished at 69 patients with spondylolisthesis staging from MEYERDING I-IV in the vertebral segments L 4-5 and L 5-S 1. By the spondylodesis we succeeded in 90% of cases in attaining a firm osseous fusion of the vertebral moving segment. In 85% we gained a good clinical result. The period of follow-up is on average of 26 months. The average age of the patients is 38.8 years.

[Indications for orthopedic procedures in old people (author's transl)]. / Erweiterte Operationsindikationen der Orthopädischen Chirurgie beim alten Menschen

Advancements in general medicine and anesthesiology have enabled surgical procedures in old people with diminished risks. With reference to special problems the absolute indication for orthopedic procedures particularly for the old can be demonstrated.

Electronic studies of gait disturbances. A new method of gait examination in patients with arthrodesis of the ankle and/or subtalar joint.

A follow-up study on 160 patients with an arthrodesis of the ankle and/or subtalar joint has been made. Besides clinical and roentgenological examinations the gait of the patients was checked with a new electronic device. In addition we tested the pressure distribution underneath the sole of the affected foot and compared it to the contralateral side. This was found to be a valuable contribution to the examination methods used and can help to give a more objective judgement of the patients subjective complaints. Besides confirming known facts it was found that there were divergent results of electronic gait studies from examinations which are based on the usual clinical and X-ray studies. This may help to improve the patient's gait by correcting mechanical aids or, in rare cases, indicating another operation.

[A contribution to the recording and study of the disease pattern of osteogenesis imperfecta tarda (author's transl)]. / Ein kasuistischer Beitrag zum Krankheitsbild der Osteogenesis imperfecta tarda.

This study aims at investigating in a group of thirty-five patients whether osteogenesis imperfecta tarda presents a uniform disease pattern in respect of clinical and roentgenological criteria, or whether it can be subdivided into clinical groups. Depending on the severity of the disease, it was possible to subdivide this into two groups: a severe form of osteogenesis imperfecta tarda, and a bland form. This subdivision was effected according to the most conspicuous symptom of frequency of the fracture. The other symptoms do not allow any subdivision into groups since their occurrence is independent of the severity of the disease pattern.

[Cement-free ACA hip total endoprosthesis--5 years results]. / Die zementfreie ACA-Hüfttotalendoprothese--5-Jahres-Ergebnisse.

AIM: Since 1994 the cementlesss AlloClasssicAdditional (ACA) total hip replacement system is used in the 1st Orthopedic Department of the Hesssing-Stiftung, Augsburg/Germany. Oblique steps on the medial and lateral side of the stem turn negative retrotorsional forces into axial forces and increase rotational stability. The new shape of the self-cutting metric thread of the dual-radius designed acetabular component provides excellent primary fixation without secondary takeover of the force transmission. We checked the medium-term results. METHODS: The titanium prosthesis (distributed by Sulzer Orthopedics/Switzerland) was used for primary total hip replacement as a complete system in 1320 cases, as a hybrid system in 96 patients. In revision arthroplasty 156 components have been implanted up to now. All patients are included in a prospective study with radiological and clinical examinations. 176 of 242 primary implanted total hip systems with a minimum follow-up of 5 years had been reviewed. RESULTS: For the minimum 5 years implanted complete systems, the Harris Hip Score rose from 42 to 91 points. 94% of the patients were mostly or completely satisfied. Thigh pain was reported in 4%. Two aseptic loosenings of the acetabular component and one aseptic loosening of the stem occurred. CONCLUSION: A high degree of osseo-integration and complications below 2% proves encouraging outcomes but final acceptance must await long-term follow-up.

[Revalgisation after intertrochanteric varus osteotomy in infancy]. / Die Revalgisierung nach intertrochanterer Varisierungsosteotomie im Kleinkindesalter

The causes for revalgisation after varus osteotomies are examined in 153 follow ups. Varus osteotomies which slow an insuffizient fixation due to faulty technic or use of Kirschner wires demonstrate only a slight degree of revalgisation. In contrast, stable fixation leads to post-operative revalgisation directly proportional to the time of rigid fixation, we therefore recommend the removal of the fixation device after osseous consolidation, i.e. after 6 months.

[Determination of minerals and trace elements in idiopathic scoliosis]. / Mineral- und Spuren- elementbestimmungen bei der idiopathischen Skoliose.

In a preliminary study the spinal processes of the curve and the parietal bone in idiopathic scoliosis were analyzed in 10 patients by atom absorption spectrophotometry during dorsal fusion operations using the Harrington instrumentarium. In addition to calcium and magnesium, the trace elements iron, copper, manganese and zinc were determined. For comparison, bone samples were taken from the pelvic ridges of the patients, as well as control biopsies from the pelvic ridges of 21 healthy patients in the clinic who were of the same age. The bone samples had been taken from the latter during surgery for pseudarthrosis. The statistical analysis of the mineral and trace elements showed that there is no local disturbance of mineral and trace element metabolism in idiopathic scoliosis; a comparison of the bone samples from the scoliosis patients with the normal values also largely ruled out a generalized disturbance of mineral and trace element metabolism in bone tissue in idiopathic scoliosis.

Damage analysis of the Harrington rod fracture after scoliosis operation.

Fracture of the distraction rod is one of the complications following operative treatment of scoliosis by the device of Harrington. It is reported to occur in about 7% of cases. We found this complication twice in our own number of 41 patients during a follow up period of 1 to 4 years. The rods had broken 18 and 23 months after operation, but we never saw a breakage in the 1st postoperative year during the time of cast fixation. The fracture surfaces of each rod were examined under the scanning electron microscope. In one case a fatigue fracture with two beginnings at the opposite sides of the rod was found in combination with a forced fracture in the middle. The number of alterations of load from the beginning of the fracture to the complete breakage was about 10,000. The X-ray showed a loss of correction in the curve of 20 degrees with a pseudoarthrosis visible in the fusion. In the other case a typical pure fatigue fracture was seen 23 months after the operation with 18,000 alterations of load. The X-ray showed only a slight loss of correction of less than 5 degrees and no pseudoarthrosis was visable, neither in the X-ray nor in the operative exploration of the fusion. The breakage of the distraction rod results not only from a pseudoarthrosis but also from other explained facts of the procedure. Further treatment depends on a proven pseudoarthrosis.

[Reduplication of femur - course observation and treatment (author's transl)]. / Femurgabelung-Verlaufsbeobachtung und Therapie.

The paper reports on the further growth of the leg in the case of a 7- year-old boy with congenital reduplication of the femur, tibial aplasia and dysplasia of the foot, who was treated conservatively until now. The possibilities of conservative and operative treatment to reconstruct the limb and to improve the function were discussed and finally the operative treatment carried out is explained. The case report is an example of the variety of problems in the reconstruction of dysplastic limbs in childhood.

[Microstructural examinations of the behavior of human cortical bone after compression osteosynthesis]. / Untersuchungen zum Verhalten der Mikrostruktur der menschlichen Corticalis nach Druckplattenosteosynthese

20 samples of human cortical bone removed from the subtrochanteric region after introchanteric femoral osteotomies with subsequent fixation by a blade plate were examined for studies of the phenomenon of cancellous transformation. Previous experiments with animals can be confirmed. A dilatation of Haver's canals in the direction from endosteum peripherally becomes apparent. This quantitative loss of cortical density is associated with a loss of mineral density. Under polarisation and scanning microscopy a derangement of collagen fibrils usually arranged in an oriented fashion can be shown. The loss of mechanical properties is discussed in connection with the derangement of orientation of collagen fibrils.

[Results of conservative treatment of scoliosis using the Milwaukee corset]. / Ergebnisse der konservativen Skoliose-Behandlung mit dem Milwaukee-Korsett.

The conservative treatment of scoliosis with Milwaukeebrace has been studied in 165 patients over a period of seven years. We have shown that good results were obtained as long as the initial did not exceed angle of 40 degrees according to COBB. When the curvature exceeds 50 degrees the progression of the scoliosis was not stopped by the MILWAUKEE-brace. In our experience the latter patients should undergo an operation. An improvement of the corrections with the conservative treatment using the MILWAUKEE-brace can only be expected when the treatment was initiated in an early state. To achieve this good propose a number of screening methods to evaluate the progressive character of the scoliosis in particular during puberty; an intensive physio-therapy and careful control of the brace are required for the success of the therapy.

[Etiological assessment of aseptic femoral head necrosis from blood serum metabolic parameters (author's transl)]. / Atiologische Beurteilung aseptischer Hüftkopfnekrosen aufgrund blutserologischer Stoffwechselparameter.

The etiological assessment of aseptic femoral head necrosis in adults is facilitated by investigation of the uric acid level and of fat metabolism parameters. From 98 of our own patients it appears that femoral head necrosis after trauma, irradiation therapy and caisson disease and after massive doses of cortisone only exceptionally shows pathological serum levels. Femoral head necrosis with manifest metabolic diseases shows 53.3% hyperuricemias and hyperlipemias or dyslipidemias. Of femoral head necroses without concomitant diseases, prior physical effects and administration of cortisone, 91% had hyperuricemia and 65% hyperlipemia or dyslipidemia.