[Comparison of the reoperation rates of three techniques for tibial tuberosity transposition in medial patellar dislocation]. / Vergleich der Reoperationsraten von drei Techniken zur Fixation der bei medialer Patellaluxation transponierten Tuberositas tibiae.

INTRODUCTION: A common technique for the treatment of medial patellar luxation is the lateral transposition of the tibial tuberosity. Two variations of a new surgical method with a retention plate and fixation with a wire or a security plate, were tested against each other and against the existing fixation with Kirschner wires and a tension band by the number of reoperations. The new method using a retention plate and security plate showed the lowest rate of reoperations (5 %), followed by the new technique using retention plate and wire (14 %) and the existing fixation with Kirschner wires and a tension band (34 %). A possible explanation for the good result of the new method can be the fixation of the implants on the medial side of the tibia and the non-use of Kirschner wires.

INTRODUCTION: La transposition latérale de la tubérosité tibiale est une technique courante pour le traitement de la luxation rotulienne médiale. Deux variantes d'une nouvelle méthode chirurgicale avec une plaque de rétention et une fixation avec un fil métallique respectivement un étrier en titane ont été testées l'une par rapport à l'autre et par rapport à la fixation usuelle avec des broches de Kirschner et un haubanage en fonction du nombre de réopérations. La nouvelle méthode utilisant une plaque de rétention et un étrier a montré le taux le plus bas de réopérations (5 %), suivie par la nouvelle technique utilisant une plaque de rétention et une broche (14 %) et la fixation usuelle avec des broches de Kirschner et un haubanage (34 %). Le bon résultat de la nouvelle méthode peut s'expliquer par la fixation des implants sur la face médiale du tibia et la non-utilisation de broches de Kirschner.

Combination of Ultrasound-Guided Percutaneous Microwave Ablation and Radioiodine Therapy in Benign Thyroid Disease: A 3-Month Follow-Up Study.

PURPOSE: Pilot studies of combined therapies treating benign nodular goiters reported promising results. The aim of this study was to investigate the effectiveness of combined microwave ablation (MWA) and radioiodine therapy (RIT) with a special focus on thyroid function at the 3-month follow-up. MATERIALS AND METHODS: 15 patients (median age: 55 years) with a large goiter and benign thyroid nodules or Graves' disease were treated with the combined therapy. Serum levels of triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), thyroglobuline (Tg) and, additionally, antibody levels against thyroglobulin (TgAb), thyrotropin receptors (TRAb) and thyroid peroxidase (TPOAb) were measured at enrollment, post MWA and at the 3-month follow-up (3MFU). Furthermore, the goiter volume, I-131 dose and hospitalization time were analyzed to evaluate effectiveness. MWA was operated under local anesthesia with a system working in a wavelength field of 902 to 928 MHz. RESULTS: TSH, T4, T3 and Tg did not change at 3MFU, except for in two patients in whom the initial TSH levels improved to normal thyroid functioning levels at follow-up. One of the patients developed a high TRAb-level that receded back into the normal range. At 3MFU, the combined therapy showed a mean thyroid volume reduction of 26.4 ml ±â€Š7.9 ml (30.5 % ±â€Š4.6 % (p < 0.05)). By utilizing the combined therapy, administered activity could be reduced by 26.6 % ±â€Š4.8 % (p < 0.05) and hospitalization time by 30.9 % ±â€Š19.9 % (p < 0.05). CONCLUSION: The data confirmed the effectiveness of the combination of MWA with RIT. The combined therapy is an innovative and conservative approach and could become a safe alternative to surgery for the treatment of very large benign nodular goiters. Due to the short follow-up and the limited number of patients, further studies will be necessary. KEY POINTS: • The combined therapy shows a significant volume reduction in benign nodular goiters. • Initial MWA improves the RIT results by reducing the required therapy activity. • Thyroid function is preserved after combined therapy.

Combination of ultrasound guided percutaneous microwave ablation and radioiodine therapy in benign thyroid diseases. A suitable method to reduce the 131I activity and hospitalization time?

AIM: Goiters and thyroid nodules are an ongoing problem in healthcare. There has not been any treatment of goiters and thyroid nodules based on the combined therapy of microwave ablation (MWA) and radioiodine therapy (RIT) until now. In this study the potential benefit of a combined therapy versus single RIT is evaluated in order to achieve improvements concerning ¹³¹I-dose and hospitalization time. PATIENTS, MATERIAL, METHODS: Ten patients with goiter and benign thyroid nodules or Graves' disease were included. Pre-ablation assessments included sonographical imaging, functional imaging with 99mTc and FNAB to collect data of nodules and total thyroid volume and to exclude malignancy. Prior to treatment, radioiodine uptake test was performed. MWA was operated under local anesthesia with a system working in a wavelength field 902-928 MHz. Post-MWA, thyroid volume was recalculated ultrasonically. Due to reduced vital volume, changes of ¹³¹I-dose and hospitalization time could be monitored. RESULTS: Mean absolute thyroid volume reduction by MWA before applying RIT was 22 ± 11 ml, meaning a relative reduction of 24 ± 6% (p < 0.05). Thereby, administered activity could be reduced by 393 ± 188 MBq using the combined therapy, reflecting a relative reduction of 24 ± 6% (p < 0.05). Additionally, mean hospitalization time was decreased by 2.1 ± 0.8 days using MWA prior to RIT, implying a relative reduction of 28 ± 6% (p < 0.05). CONCLUSION: Depending on ablated volume by MWA, RIT-monotherapy requires on average 31.2% more ¹³¹I-activity than the combined therapy. The combined therapy remarkably decreases ¹³¹I-dose and hospitalization time. The combined MWA and RIT therapy is a considerable, effective and safer alternative to surgery for the treatment of very large benign nodular goiters.

[Histological criteria and metastasis of squamous cell carcinoma of the pinna]. / Histologische Kriterien und Metastasierungshäufigkeit von Plattenepithelkarzinomen der Ohrmuschel.

INTRODUCTION: According to the guidelines for cancer of the skin in the head and neck region of the German association of Otolaryngology, Head and Neck surgery squamous cell carcinoma (SCC) of the pinna are classified by using the current TNM system of skin cancer. As soon as cartilage is infiltrated, irrespective of other criteria like tumour size, SCC of the thin skin of the pinna are classified as T4 category. As therapy considerably depends on the TNM stage a review of the prognostic value of cartilage infiltration as well as other histological criteria seems to be justified. METHODS: Medical records of all patients (n = 36) being operated for SCC of the pinna between August 1988 and January 2004 at our department were retrospectively analysed with regard to a statistical correlation of histological criteria, cervical lymph node metastases and prognosis. RESULTS: In 36 cases a histological re-evaluation could be performed on the original tumour samples (34 male symbol : 2 female symbol; average age was 76 years, with an age interval of 54 - 99 years). 26 SCC cases were smaller than 2 cm, 8 cases between 2 and 5 cm and 2 cases bigger than 5 cm of size. 36 % of SCC cases had infiltration of the auricular cartilage. Statistical analysis did not show a statistical correlation of either cartilage infiltration, tumour size bigger than 2 cm or 1 cm, tumour grading and tumour depth with regard to lymph node metastases. DISCUSSION: According to our results, cartilage infiltration as single criterion of inclusion into a T4 category should be analysed cautiously. The anatomical peculiarity of the pinna where cartilage lies directly beneath very thin skin should be taken into account. A survey of a bigger group of patients e. g. as a multicenter study would be desirable for such a rare malignancy.

[Perineal hernia in dogs--colopexy, vasopexy, cystopexy and castration as elective therapies in 32 dogs]. / Perineale Hernie beim Hund--Colopexie, Vasopexie, Cystopexie und Kastration als Therapie der Wahl bei 32 Hunden.

In 32 male dogs colopexy, vasopexy, cystopexy and castration was performed for the treatment of perineal hernia. Recurrence rate in this study is 22%, what is comparable to other studies using different methods. The degree of severity and the number of complications is lower with this technique than with others. Enlargement of the prostate was evident in 59% and bladder retroflexion in 22% of the dogs. A celiotomy allows to recognize, assess, reduce and fix displaced organs which is not possible by using other methods. The aim is to regain the tubular structure of the ampulla recti and to fix prostate and bladder cranioventrally to the pelvic entrance. The castration performed at the same time causes the prostate gland to atrophy within 2-3 weeks, what makes the pelvic entrance even wider and the dogs return to normal defecation.

Aryl sulfatase inactivation of slow reacting substance. Evidence for proteolysis as a major mechanism when ordinary commercial preparations of the enzyme are used.

Type II B arylsulfatases are known to inactivate slow reacting substance (SRS), but the mechanism is unclear. In the present study, ordinary commercial preparations of Sigma limpet arylsulfatase largely inactivated the glutathionyl and cysteinyl-glycyl forms of SRS, but the cysteinyl form of SRS was largely resistant to the enzyme. Evidence is presented which established that a major mechanism for the inactivation of the glutathionyl and cysteinyl-glycyl SRS types, at least by the particular enzyme preparations we have studied, involves cleavage of the glycine moiety from the sulfur containing side chain. This was confirmed by digestion studies with glutathione itself. In addition, there is some evidence to indicate that the enzyme may destabilize the double bond structure of the SRS molecule, contributing to the overall inactivation.