[Treatment of chronic slipped capital femoral epiphysis : Use of dynamic epiphyseal telescopic screws]. / Behandlung der chronischen Epiphyseolysis capitis femoris : Einsatz der dynamischen epiphysären Teleskopschraube.

BACKGROUND: Slipped capital femoral epiphysis (SCFE) is a multifactorial structural loosening in the area through the epiphyseal plate between the epiphysis and metaphysis accompanied by slippage of the femoral head in the mid-dorsal-caudal direction without additional adequate trauma. In this retrospective study, all patients with chronic SCFE were assessed who had been treated by implanting a dynamic epiphyseal telescopic (DET) screw. METHODOLOGY: All patients who had been treated at our hospital with a DET screw implant between December 2006 and November 2014 following diagnosis of chronic SCFE were included in the study. Clinical and radiological follow-up was carried out after 6 weeks, 12 weeks, and then every 6 months. RESULTS: In all patients, the SCFE proved to have been firmly fixed and no further slippage was observed in any patient on the side affected. None of the prophylactically treated hips showed secondary SCFE either. In all patients, the DET screw led to partial remodeling of the slippage. The average slippage angle according to Southwick (epsilon angle) was about 30° preoperatively and about 19° in the most recent radiological follow-up. The alpha angle according to Nötzli was about 91° preoperatively and about 62° in the most recent radiological follow-up. Most of the patients showed none treatment-related dysfunction. CONCLUSION: Surgical treatment with a DET screw seems to be a safe procedure for both the affected hip and the hip to be treated prophylactically. This method is an adequate alternative to the widespread technique of pinning with K­wires.

[Pavlik harness for the treatment of congenital hip dysplasia types D III and IV]. / Pavlik-Bandage zur Therapie der kongenitalen Hüftdysplasie Typ D, III und IV.

BACKGROUND: Up to 4% of all neonates in Central Europe are born with congenital hip dysplasia (CHD), the most common congenital disease of the musculoskeletal system. However, in this retrospective analysis the outcomes of infants with CHD (type D, III or IV according to Graf) have been considered, with Pavlik therapy starting within the first 12 weeks of life. Connections between the start of therapy or the first finding according to Graf`s classification and the ultrasound result achieved, as well as the X-rays taken after 1 and 2 years, were evaluated. No repositioning under Pavlik treatment or side effects and their relevance have been evaluated, especially with regard to avascular necrosis (AVN) of the femoral head. MATERIALS AND METHODS: All infants treated using Pavlik treatment for CHD between 2010 and 2012 in our clinic were determined. A total of 62 patients with 79 pathological hips were included. The infants were classified into three groups to evaluate the influence of the start of therapy on the result: group I with the first investigation and start of treatment within the first 10 days of life, group II between the 11th day and the end of week 3, group III within preventive general examinations (U3) after the 4th week. Clinical examinations and the usual ultrasound scans were performed at an average of 1, 3, and 6 months. Furthermore, after 1 and 2 years clinical and radiological investigations were carried out, as well as further examinations depending on the findings. RESULTS: A failure of repositioning of the Pavlik treatment occurred in group I in 1 case (2.2%), in group II in 1 case (7.1%), and in group III in 2 cases (10%). This occurs in hips type D and type III in 1 case each (3.3%) and type IV in 2 cases (10.5%). Maturation disorders of the hips were found in 1 case (2.2%) in group I, 1 case (7.1%) in group II, and 3 cases (15%) in group III. Avascular necrosis of the femoral head was proven in 2 cases (4.4%) in group I, 0% in group II, and in 1 case (5%) in group III. All patients initially had femoral head necrosis of Graf type IV . All necrosis and maturation disorders were no longer visible on subsequent examinations after 2 years at the most. CONCLUSIONS: In summary, the study shows that even with a late treatment start (U3) good results could be achieved, but with a rising number of repositioning failures and femoral necroses. Ultrasound screening on U3 seems to be sufficient; however, for high-risk groups an additional screening in the first week of life should be performed, which does not replace a second evaluation at U3 if there are normal findings.

Simultaneous [18F]FDG-PET/MRI: Correlation of Apparent Diffusion Coefficient (ADC) and Standardized Uptake Value (SUV) in Primary and Recurrent Cervical Cancer.

OBJECTIVES: Previous non-simultaneous PET/MR studies have shown heterogeneous results about the correlation between standardized uptake values (SUVs) and apparent diffusion coefficients (ADCs). The aim of this study was to investigate correlations in patients with primary and recurrent tumors using a simultaneous PET/MRI system which could lead to a better understanding of tumor biology and might play a role in early response assessment. METHODS: We included 31 patients with histologically confirmed primary (n = 14) or recurrent cervical cancer (n = 17) who underwent simultaneous whole-body 18F-FDG-PET/MRI comprising DWI. Image analysis was performed by a radiologist and a nuclear physician who identified tumor margins and quantified ADC and SUV. Pearson correlations were calculated to investigate the association between ADC and SUV. RESULTS: 92 lesions were detected. We found a significant inverse correlation between SUVmax and ADCmin (r = -0.532, p = 0.05) in primary tumors as well as in primary metastases (r = -0.362, p = 0.05) and between SUVmean and ADCmin (r = -0.403, p = 0.03). In recurrent local tumors we found correlations for SUVmax and ADCmin (r = -0.747, p = 0.002) and SUVmean and ADCmin (r = -0.773, p = 0.001). Associations for recurrent metastases were not significant (p>0.05). CONCLUSIONS: Our study demonstrates the feasibility of fast and reliable measurement of SUV and ADC with simultaneous PET/MRI. In patients with cervical cancer we found significant inverse correlations for SUV and ADC which could play a major role for further tumor characterization and therapy decisions.

Invasive cardiac aspergillosis after orthotopic liver transplantation.

Invasive aspergillus infection occurs in 5 - 42 % of liver-transplanted recipients and is a dangerous complication, associated with high mortality if untreated. However, the early diagnosis of invasive aspergillosis can be elusive, as clinical signs are unspecific and the pathogenic agent is difficult to demonstrate. We here report about a 58-year-old man with acute liver failure caused by newly diagnosed chronic hepatitis B infection who underwent liver transplantation. The postoperative course was uneventful, and the patient was discharged after 30 days. After 105 days the patient was readmitted because of fever, recurrent chest and abdominal pain. Computed tomography revealed a cardiac lesion; other diagnostic steps including bone-marrow and endomycordial biopsy, virological and microbiological investigations gave no clear findings. To exclude a malignant process, thoracotomy with mass and simultaneous lower left lobe resection were performed. Histopathological findings revealed an invasive perimyocardial aspergillosis. Immediate intravenous therapy with voriconazole and caspofungin was initiated and monitoring of the mass was performed with transesophageal echocardiography and Cardio-MRI. Due to slightly increase of the lesion, medication was switched to posaconazole and caspofungin. Under this dual fungal treatment the lesion regressed and the patient could be discharged after two months in good clinical condition. Frequent Cardio-MRI scan after discharge showed further mass-regression. Therefore antifungal treatment was switched to oral posaconazole mono-therapy. After one year, complete reduction of the mass was achieved and antifungal therapy was discontinued. Recent diagnostic imaging follow-up showed no pathological finding.

[Superinfected epidermal inclusion cyst of the thigh with development of squamous cell carcinoma--case report of a rare complication]. / Superinfektion einer epidermalen Inklusionszyste des Oberschenkels mit Ausbildung eines Plattenepithelkarzinoms--Fallbericht einer seltenen Komplikation.

Epidermal cysts (atheroma) are the most common benign tumours of the skin with ubiquitous localisation all over the body. However, rupture of the atheroma and formation of an inclusion cyst with additional superinfections are frequently seen. Malignant transformations have rarely been reported. Presented here is the unusual case of a 65-year-old woman with multiple atheromas and a distinctive tumour of the upper limb. Imaging diagnostics showed malignant deformation. Contrary to the imaging findings the histological/microbiological examination showed an enormous superinfected and ruptured epidermoid cyst with multiple abscess formation in the ventral upper limb. Radical surgical restoration with salvage of the limb was frustrated because of honey-combed anterior soft tissue and the changing bacterial spectrum. After resection of the complete ventral compartment, remission was realised approximately. In the follow-up there was a recurring infection with spontaneous fistula formation that histologically impressed as a squamous cell carcinoma. After proximal ablation of the upper limb, total rehabilitation of the infection as well as the malignoma could be achieved.

[Secondary telangiectatic osteosarcoma of the left femur. A case presentation of an unusual course of disease]. / Sekundäres teleangiektatisches Osteosarkom des linken Femurs. Darstellung eines ungewöhnlichen Krankheitsverlaufs.

BACKGROUND: This article presents the unusual case of a 73-year-old male patient who was treated with primary interlocking nailing after a pathological femoral fracture. DIAGNOSTICS: Despite comprehensive diagnostics including several biopsies, a tumor could not be detected. In 2008 when progressive cystic femoral destruction leading to loosening of the nail necessitated a partial femoral prosthesis, an osteosarcoma could first be diagnosed in the resected bone. THERAPY: Advanced progression of the tumor required an extended hip exarticulation. During the current restaging of the now 84-year-old patient no tumor could be detected. CONCLUSION: When a malignancy cannot be excluded even by repeated biopsies of radiologically suspicious structures, an adequate tumor staging followed by close monitoring should be carried out. For a clinically silent, long-term course of cystic destruction of a long bone over several years, an age over 60 years and a lack of distant metastases, an atypical osteosarcoma should be considered in the differential diagnosis.

[Case report about a 35 year old patient with cystic fibrosis and metastatic pancreatic cancer]. / Fallbericht eines 35 Jahre alt gewordenen Patienten mit Mukoviszidose und einem metastasierten Pankreaskarzinom.

Cystic fibrosis is the most common lethal genetic disease in Caucasian population. End-stage lung disease is the most frequent cause of death, however since therapeutic options have improved the life expectancy of patients with cystic fibrosis, increased incidences of gastrointestinal tumors including pancreatic carcinoma have been reported in several cohort studies from the USA and Europe. We report about a 35-year-old male patient who died from cystic fibrosis with a pancreatic carcinoma, which was histologically confirmed by autopsy. Additionally a low grade appendiceal mucinous neoplasm (LAMN) was diagnosed.