[Management of persistent colitis after successful immunotherapy for non-small cell carcinoma of the lung]. / Management einer persistierenden Kolitis nach erfolgreicher Immuntherapie eines nicht-kleinzelligen Karzinoms der Lunge.

Immune checkpoint inhibitors have shown remarkable efficacy as new-generation drugs in anti-tumor therapy. However, the nonspecific activation of the immune system leads to a number of adverse side effects, so-called immune-related adverse events (irAEs), including the occurrence of diarrhea and colitis in about one third of treated patients.Endoscopically and histologically, there is significant overlap of immune-mediated colitis with classic IBD, making differentiation difficult.Therapeutically, high-dose glucocorticoids are used in grade 3 (severe) to grade 4 (life-threatening) colitis, in addition to discontinuation of ICI therapy. Steroid-refractory cases (up to 42%) benefit from the TNF inhibitor infliximab. Vedolizumab, analogous to inflammatory bowel disease, represents second-line therapy for infliximab-refractory cases. Little data exist to date on the efficacy of tofacitinib in refractory cases.We describe the case and therapeutic management of severe and persistent immune-mediated colitis after successful immunochemotherapy with pembrolizumab in an 80-year-old man with metastatic non-small cell carcinoma of the lung and pre-existing colitis unclassified and other comorbidities.

The need for secondary resurfacing is affected by trochlear height in total knee arthroplasty.

PURPOSE: The purpose of the study was to compare the rate of secondary resurfacing in a consecutive series of five different total knee arthroplasty (TKA) systems. It was our hypothesis that different TKA design features such as sulcus angle or trochlear height influence the rate of secondary resurfacing. METHODS: A retrospective study was performed on data from patients who underwent TKA without primary patellar resurfacing from 2004 to 2012 in an university-affiliated hospital. The study cohort included 784 TKA patients (m:f = 302:482, mean age at surgery ± SD 71 ± 10). Five different cruciate-retaining TKA systems were used consecutively (Group A, Triathlon, Stryker, Switzerland (n = 296), Group B, PFC Sigma, DepuySynthes, Switzerland (n = 215), Group C, LCS, DepuySynthes, Switzerland (n = 81), Group D, Balansys, Mathys, Switzerland (n = 128), Group E, Duracon, Stryker, Switzerland (n = 64)). Data were retrospectively obtained from hospital archives. Patients demographics, age at surgery, type of TKA were noted. In addition, TKA component position was assessed on radiographs with respect to "The knee society total knee arthroplasty roentgenographic evaluation and scoring system" (TKA-RESS). Pearson Chi-square test was used to compare differences between groups (p < 0.05). There were no significant differences between the groups in terms of age, gender, and radiological outcomes. RESULTS: Twenty-six of 784 patients (3.3 %) underwent secondary resurfacing due to patellofemoral pain. In group A 4/296 patients (1.4 %), in group B 15/215 patients (7 %), in group C 5/81 patients (6.2 %), in group D 1/128 patients (0.8 %), in group E 1/64 patients (1.6 %) underwent secondary patellar resurfacing during follow-up. Significantly higher rates of secondary patellar resurfacing were seen in groups B and C when compared to the others (p < 0.001). It was found that the trochlear height in these TKA was higher than in the others. CONCLUSIONS: Based on the findings of this study, trochlear height influences the need for secondary patellar resurfacing. The resurfacing rate ranged from 1 to 7 %, with the highest rate in the PFC Sigma TKA. LEVEL OF EVIDENCE: Therapeutic study, Level III.

Cross-sectional Vascularization Pattern of the Adipofascial Anterolateral Thigh Flap for Application in Tissue-engineered Bone Grafts.

As part of the engineering of bone grafts, wrapping constructs in well-vascularized tissue, such as fascial flaps, improves bone formation. Our aim was to understand the cross-sectional vascularization pattern of human adipofascial flaps for this application. METHODS: Seven adipofascial anterolateral thigh (ALT) flaps were harvested from five human cadaveric specimens. Axial vessel density was analyzed by immunohistochemistry and quantitative histology. RESULTS: We found a high density of blood vessels directly superficial to and close to the fascia. A secondary plexus in between this first suprafascial plexus and the subdermal plexus was also identified. In all specimens, this second plexus showed less vascular density, and appeared to be at a constant level within the suprafascial fat throughout the flaps. The peak measurements for this secondary plexus varied between 1.2 and 2 mm above the deep fascia, depending on the donor's body mass index. CONCLUSIONS: Quantitative immunohistochemistry is a reliable method to quantify and locate vessel density in an adipofascial flap. This is vital information before wrapping nonvascularized material into such a flap to estimate the inosculation potential of these vessels and likelihood of survival of the tissue. To profit from both suprafascial vascular plexuses, a correlation between subcutaneous tissue thickness and distance of the second plexus to the fascia should be further investigated. For the moment, we recommend maintaining at least 2-3 mm of subcutaneous fatty tissue on the fascia, to profit from both plexuses. Engineered constructs should be wrapped on the superficial medial side of the fascial flap to enhance vascularization.