RÉSUMÉ
BACKGROUND: There are clear standards for when to operate on both distal epiphyseal and diaphyseal forearm fractures in children. However, paediatric surgeons are often faced with fractures in the transition zone between metaphysis and diaphysis. This aim of the study is to compare different treatment approaches for diametaphyseal forearm fractures, to classify different types of these fractures, and to define further assessment parameters and treatment recommendations. METHODS: This retrospective study included all patients with diametaphyseal radial fractures who were seen at a paediatric surgery clinic between 01.01.2010 and 31.12.2013. Patients were treated either non-surgically (C) or surgically using bicortical Kirschner wire (BC-KW), intramedullary K-wire (IM-KW), elastic stable intramedullary nailing (ESIN), or combined bicortical and intramedullary K-wire (BCIM-KW). RESULTS: During the study period, 547 patients presented with forearm fractures of which 88 patients (16%) had a fracture in the diametaphyseal region. The majority of diametaphyseal fractures were greenstick fractures (54.4%) followed by transverse fractures (44.3%). Distal fractures were predominantly treated with bicortical K-wiring (BC-KW, 40.5%) or non-surgically (C, 26.2%). Proximal fractures were treated by ESIN osteosynthesis (50%), followed by IM-KW (30%). Intermediate fractures were just as likely to be treated with one out of the 5 above-mentioned techniques. The ulna was involved in 64 of 88 cases. Depending on the type of fracture, it was treated either by ESIN osteosynthesis or non-surgically. No superior operative technique was identified. CONCLUSIONS: The description of diametaphyseal fractures as a separate entity is important, because the therapy of these fractures is heterogeneous and challenging. A classification into proximal, intermediate, and distal may be useful in clinical decision-making. Despite the retrospective nature of this study, our data suggest that the use of a K-wire or combined technique BCIM-KW-technique, whenever technically feasible, achieves better radiological results without secondary dislocation. Further prospective studies are needed to provide better guidance to trauma surgeons.
Sujet(s)
Traumatismes de l'avant-bras , Ostéosynthese intramedullaire , Fractures du radius , Enfant , Humains , Études rétrospectives , Fractures du radius/imagerie diagnostique , Fractures du radius/chirurgie , Radius , Traumatismes de l'avant-bras/complications , Traumatismes de l'avant-bras/chirurgie , Ostéosynthèse interne , Ostéosynthese intramedullaire/effets indésirables , Résultat thérapeutique , Clous orthopédiquesRÉSUMÉ
The flagellar beating of a spermatozoa's axoneme is caused by the varying activation and inactivation of dynein molecules. Dynein, axonemal, light chain 4 (DNAL4) is a functional candidate gene for sperm motility as it encodes a small subunit of the dyneins. We resequenced the porcine DNAL4 using three artificial insemination (AI) boars each with high (>68%) or low (<60%) motility, and detected 23 SNP. These were then genotyped for 82 AI boars. Using spermatological records, significantly negative genetic correlations between ejaculate volume (VOL) and the further spermatological parameters concentration (CONC) (r = -.43), motility of undiluted semen (MOTUD) (r = -.09), motility after 24 h (MOT1) (r = -.17) and after 48 hr (MOT2) (r = -.23) were estimated. Significantly positive correlations existed between CONC and MOT1 (r = .07) as well as MOT2 (r = .10), between MOTUD and MOT1 (r = .33), between MOTUD and MOT2 (r = .36), and finally between MOT1 and MOT2 (r = .70). Significantly negatively correlated were all motility traits with the parameters abnormal acrosome (AA) (MOTUD r = -.06; MOT1 r = -.08, and MOT2 r = -.1) and presence of cytoplasmic droplet (CD) (MOTUD r = -.07; MOT1 r = -.08; MOT2 r = -.07). Association analyses (single marker regression model; SMR) propose that SNP g.1007A>G, located in the second intron, reduces motility significantly (MOTUD -4.59%; MOT1 -10.33%; MOT2 -19.37%). According to the dominant-recessive model (DRM), genotype AA is always superior compared to genotypes AG and GG (i.e. MOTUD 67.67%, 64.16% and 53.91%; MOT1 54.17%, 43.75% and 28.44%; MOT2 44.12%, 24.91% and 4.97%). The average effect of gene substitution (g.1007A>G) on abnormal midpiece (AM) was 0.71%, the genotypic values-as expressed by LSmeans-were 0.1 (AA) and 0.81 (AG).
Sujet(s)
Dynéines/génétique , Mobilité des spermatozoïdes/génétique , Spermatozoïdes/malformations , Sus scrofa/génétique , Acrosome/anatomopathologie , Animaux , Insémination artificielle/médecine vétérinaire , Mâle , Polymorphisme de nucléotide simple , Analyse du sperme , Spermatozoïdes/anatomopathologieRÉSUMÉ
AIM: To determine the CO2 permeability (PCO2 ) of plasma membranes of cardiomyocytes. These cells were chosen because heart possesses the highest rate of O2 consumption/CO2 production in the body. METHODS: Cardiomyocytes were isolated from rat hearts using the Langendorff technique. Cardiomyocyte suspensions exhibited a vitality of 2-14% and were studied by the previously described mass spectrometric 18 O-exchange technique deriving PCO2 . We showed by mass spectrometry and by carbonic anhydrase (CA) staining that non-vital cardiomyocytes are free of CA and thus do not contribute to the mass spectrometric signal, which is determined exclusively by the fully functional vital cardiomyocytes. RESULTS: Lysed cardiomyocytes yielded an intracellular CA activity for vital cells of 5070; that is, the rate of CO2 hydration inside the cell is accelerated 5071-fold. Using this number, analyses of the mass spectrometric recordings from cardiomyocyte suspensions yield a PCO2 of 0.10 cm s-1 (SD ± 0.06, n = 15) at 37 °C. CONCLUSION: In comparison with the PCO2 of other cells, this value is quite high and about identical to that of the human red cell membrane. As no major protein CO2 channels such as aquaporins 1 and 4 are present in rat cardiac sarcolemma, the high PCO2 of this membrane is likely due to its low cholesterol content of about 0.2 (mol cholesterol)·(mol total membrane lipids)-1 . Previous work predicted a PCO2 of ≥0.1 cm s-1 from this level of cholesterol. We conclude that the low cholesterol establishes a PCO2 high enough to render the membrane resistance to CO2 diffusion almost negligible, even under conditions of maximal O2 consumption of the heart.
Sujet(s)
Dioxyde de carbone/métabolisme , Carbonic anhydrases/métabolisme , Membrane cellulaire/physiologie , Myocytes cardiaques/métabolisme , Animaux , Hydrogénocarbonates/métabolisme , Carbonic anhydrases/génétique , Perméabilité des membranes cellulaires , Cellules cultivées , Cholestérol/pharmacologie , Régulation de l'expression des gènes codant pour des enzymes , Spectrométrie de masse , Consommation d'oxygène , Perméabilité , RatsRÉSUMÉ
Recent insemination techniques bypass the interactions between sperm and the uterine wall because the semen is deposited deep into the tip of uterine horn or directly into the oviduct. Such techniques allow high dilution of the ejaculates. After normal mating, semen entering the uterus communicates with the uterine milieu. Intact sperm of high mitochondrial membrane potential bind to uterine epithelial cells, whereas most of the unbound sperm in the uterine lumen have damaged membranes. Lectins are the most likely factors to mediate these sperm-uterine interactions. The lectin wheat germ agglutinin is known to induce the strongest binding of sperm, whereas binding is impaired when sialic acid receptors are blocked by wheat germ agglutinin. This suggests that sialic acid is involved in porcine sperm-endometrium interactions, and it is hypothesized that the use of a semen extender supplemented with sialidase would allow insemination with reduced sperm numbers. A lack of contact of sperm and seminal plasma with the uterine wall, as a result of deep insemination, may adversely affect (1) events during ovulation, (2) induction of immunologic tolerance against paternal antigens, (3) preparation of the endometrium for implantation and placentation, and (4) immunologic support required for the fetus during pregnancy. Seminal plasma is known to signal post-insemination changes in the uterine endometrium involving the redistribution of leukocytes. This may involve migration of leukocytes from the uterine wall to the ovary, as seminal plasma particularly increases the appearance of the major histocompatibility complex class II-positive cells. Uterine epithelial cells respond to sperm binding by the production of pro- or anti-inflammatory cytokines. These cytokines may include synchronizing substances, transferred through a counter-current pathway to the ipsilateral ovary, thereby accelerating the final maturation of preovulatory follicles and advancing time of ovulation. In several species, an ovulation-inducing factor exists in seminal plasma, first identified as ß-nerve growth factor in camelid semen, indicating another pathway that influences the hypothalamic-pituitary-gonadal axis. In summary, low-dose inseminations may not necessarily require semen deposition deep into the uterine horn, as binding inhibitors can circumvent the binding of sperm to the uterine wall. However, subsequent immune-relevant events that control ovulation and prepare the uterine milieu for the developing embryo should be taken into account.
Sujet(s)
Insémination artificielle/médecine vétérinaire , Conservation de semence/médecine vétérinaire , Sperme/physiologie , Animaux , Femelle , Insémination artificielle/méthodes , Mâle , GrossesseRÉSUMÉ
The anatomy and histology of the reproduction organs of the male Babirusa (Babyrousa celebensis) were studied in 21 specimens collected between birth and approximately 17 years of age. In adult animals the testes were located in a subanal position against the caudal surface of the thigh musculature. Average adult testis length was 68.9 ± 5.1 mm, width was 40.3 ± 5.7 mm, and depth was 47.9 ± 7.0 mm (N = 11). The average combined adult testicular weight was estimated to be 82.7 ± 23.2 g (N = 11). The testes of newborn Babyrousa had descended through the inguinal canal into the scrotum before birth. Adult seminiferous tubules had an average diameter of 199 ± 33.6 µm (N = 9) and were randomly distributed among a smaller volume of Leydig cells. Connective tissue was sparse. In one 13-month-old prepubertal animal the diameter of the seminiferous tubules was 85.3 ± 16.1 µm (N = 7). The spermatozoa was 42.2 ± 4.9 µm (N = 19) long and had a flat, paddle shaped head, 6.3 ± 0.6 µm (N = 50) long, 3.9 ± 0.5 µm (N = 47) wide, and a thickness of approximately 0.5 µm. An apical ridge along its front represented the acrosome. The two adult vesicular glands each had an irregular shape and were approximately 48.7 ± 7.4 mm long, 25.6 ± 4.3 mm wide, and 20.6 ± 8.7 mm deep (N = 6). The prostate, comprising a corpus and disseminate parts, lay ventral to the vesicular glands partly embedded in the dorsal wall of the urethra. The paired adult bulbourethral glands were approximately shaped like prolate (elongated) spheroids and had a length of 51.2 ± 14.2 mm, a width of 22.6 ± 4.5 mm, and a depth of 14.4 ± 4.5 mm (N = 7). The secretions from the bulbourethral glands drained into the urethral recess, which in adults measured approximately 10 to 14 mm in length and was located caudodorsal to a narrowing of the pelvic urethra. The penis was 330 ± 16 mm long and 8.2 ± 0.6 mm in diameter, and rotated approximately two and a half turns counterclockwise along its longitudinal axis toward its free end. The small prepucial diverticulum situated dorsocranial to the penis tip in adult and prepubertal Babyrousa, in adults measured 22.0 ± 1 mm in length and 17.5 ± 2.6 mm (N = 3) in width.
Sujet(s)
Système génital de l'homme/anatomie et histologie , Suidae/anatomie et histologie , Facteurs âges , Animaux , Mâle , Maturation sexuelle , Spermatozoïdes/cytologie , Spermatozoïdes/ultrastructureRÉSUMÉ
Pre-selection of spermatozoa based on the relative DNA difference between X- and Y-chromosome bearing populations by flow cytometry is an established method that has been introduced into commercial cattle production. Although several important improvements have increased the sort efficiency, the fertilising ability of sexed spermatozoa based on offspring per insemination is still behind farmers' expectations. The main stress factors, especially on mitochondria, that reduce the lifespan of spermatozoa are described, and new technical as well as biological solutions to maintain the natural sperm integrity and to increase the sorting efficiency are discussed. Among these methods are the identification of Y-chromosome bearing spermatozoa by bi-functionalised gold nanoparticles and triplex hybridisation in vivo as well as new laser-controlled deflection system that replaces the deflection of spermatozoa in the electrostatic field. Additionally, as well as a new nonsurgical transfer system of spermatozoa into the oviduct of cows has been developed and allows a significant reduction of spermatozoa per transfer. Altogether, the improvements made in the recent years will allow a broader use of sex-sorted spermatozoa even in those species that require more cells than cows and sheep.
Sujet(s)
Animaux domestiques , Sélection/méthodes , Insémination artificielle/méthodes , Présélection du sexe/méthodes , Spermatozoïdes/cytologie , Animaux , Bovins , ADN/analyse , Femelle , Cytométrie en flux/méthodes , Mâle , Nanoparticules métalliques , Ovis aries , Chromosome X/composition chimique , Chromosome Y/composition chimiqueRÉSUMÉ
This study for the first time screens microsatellite markers for associations with the temperature-dependent sex of Oreochromis niloticus. Previous studies revealed markers on linkage groups (LG) 1, 3, and 23 to be linked to the phenotypic sex of Oreochromis spp. at normal rearing temperatures. Moreover, candidate genes for sex determination and differentiation have been mapped to these linkage groups. Here, 6 families of a temperature-treated genetically all-female (XX) F(1)-population were genotyped for 21 microsatellites on the 3 LGs. No population-wide QTL (quantitative trait loci) or marker trait associations could be detected. However, family-specific QTL were found on LG 1 flanked by UNH995 and UNH104, on LG 3 at the position of GM213, and on LG 23 next to GM283. Moreover, family-specific single marker associations for UNH995 and UNH104 on LG 1, GM213 on LG 3, as well as for UNH898 and GM283 on LG 23 were detected. Yet, marker trait associations could not explain the temperature-dependent sex of all fish in the respective families. The molecular cue for the temperature-dependent sex in Nile tilapia might partially coincide with allelic variants at major and minor genetic sex determining factors. Moreover, additional QTL contributing to variable liabilities towards temperature might persist on other LGs.
Sujet(s)
Cichlides/génétique , Locus de caractère quantitatif/génétique , Processus de détermination du sexe/génétique , Température , Animaux , Cartographie chromosomique , Croisements génétiques , Femelle , Études d'associations génétiques , Liaison génétique , Marqueurs génétiques , Génétique des populations , Mâle , PhénotypeRÉSUMÉ
The advantages and shortcomings of focused microwave-induced combustion (FMIC) for digestion of plant samples were studied. The effects of sample mass, absorbing solution, oxygen gas flow-rate, and time of reflux step on recoveries of major, minor and trace metals were systematically evaluated. Afterwards, Al, Ba, Ca, Co, Cr, Cu, Mg, Mn, Ni, Sr, V, and Zn were determined by inductively coupled plasma optical emission spectrometry (ICP OES) and by inductively coupled plasma mass spectrometry (ICP-MS). The main advantages of FMIC when compared to microwave-assisted wet digestion (MAWD) and focused-microwave-assisted wet digestion (FMAWD) are the possibility to digest larger masses of samples (up to 3g) using shorter heating times and diluted nitric acid solution for absorbing all analytes. Using the selected experimental conditions for FMIC, residual carbon content was lower than 0.7% for all samples and relative standard deviation (RSD) varied from 1.5 to 14.1%. Certified reference materials (NIST 1515 apple leaves and NIST 1547 peach leaves) were used for checking accuracy and determined values for all metals were in agreement with certified values at a 95% confidence level. No statistical difference (ANOVA, 95% of confidence level) was observed for results obtained by FMIC, FMAWD, and MAWD. Limits of detection were lower when using FMIC in the range of 0.02-0.15 µg g(-1) for ICP OES and 0.001-0.01 µg g(-1) for ICP-MS, which were about 3 and 6 times lower than the values obtained by FMAWD and MAWD, respectively. It is important to point out that FMIC was a suitable sample preparation method for major, minor and trace metals by both determination techniques (ICP OES and ICP-MS). Additionally, since it allows lower LODs (because up to 3g of sample can be digested) and diluted acid solutions are used (without any further dilution), the use of ICP-MS is not mandatory.
Sujet(s)
Métaux/analyse , Plantes/composition chimique , Carbone/composition chimique , Température élevée , Limite de détection , Spectrométrie de masse , Micro-ondes , Acide nitrique/composition chimique , Oxygène/composition chimique , Spectrophotométrie atomiqueRÉSUMÉ
The mtDNA control region of 72 Thai native pigs and 11 Thai wild boars indigenous to Northern Thailand was comparatively sequenced. In total, 36 nucleotide variations that accounted for 24 haplotypes have been described (TNH01 to TNH20 and TWH01 to TWH04). These haplotypes and further publicly available mtDNA haplotypes were used to assess phylogenetic relationships. Twenty-three of the 24 haplotypes became integrated into the Asian clade of the phylogenetic tree and eight of them recapitulated another major cluster of haplotypes within this clade (Thai haplogroup, THG). Only haplotype TNH01 fit in with the European clade of the phylogenetic tree. An additional analysis using 510 bp of the mtDNA incorporated the THG haplotypes in to clade MTSEA (mountainous and Southeast Asian distribution) to form haplogroup MTSEA-THG. Recently, MTSEA was renamed in MC3. MC3 contains only signatures of pigs scattered across the Indo-Burma Biodiversity Hotspot (IBBH), a region including Thailand to the Kra Isthmus. Here we propose a putative independent porcine domestication event in South-east Asia (SEA). All haplotypes of haplogroup MTSEA-THG have revealed unique and previously unknown nucleotide signatures at positions 24 (nucleotide A) and at positions 183 (nucleotide C) that differentiate them from all other porcine mtDNA haplotypes.
Sujet(s)
Animaux domestiques/génétique , ADN mitochondrial/génétique , Variation génétique , Haplotypes/génétique , Phylogenèse , Sus scrofa/génétique , Animaux , Séquence nucléotidique , Analyse de regroupements , Biologie informatique , Démographie , Géographie , Fonctions de vraisemblance , Modèles génétiques , Données de séquences moléculaires , Analyse de séquence d'ADN , Spécificité d'espèce , ThaïlandeRÉSUMÉ
Child protection can only be successfully solved by interdisciplinary cooperation and networking. The individual, heterogeneous, and complex needs of families cannot be met sufficiently by one profession alone. To guarantee efficient interdisciplinary cooperation, there should not be any gaps in the network. In addition, each actor in the network should be placed at an optimal position regarding function, responsibilities, and skills. Actors that serve as allocators, such as pediatricians or youth welfare officers, should be in key player positions within the network. Furthermore, successful child protection is preventive and starts early. Social network analysis is an adequate technique to assess network structures and to plan interventions to improve networking. In addition, it is very useful to evaluate the effectiveness of interventions like round tables. We present data from our pilot project which was part of "Guter Start ins Kinderleben" ("a good start into a child's life"). Exemplary network data from one community show that networking is already quite effective with a satisfactory mean density throughout the network. There is potential for improvement in cooperation, especially at the interface between the child welfare and health systems.
Sujet(s)
/statistiques et données numériques , Communication interdisciplinaire , Équipe soignante/statistiques et données numériques , Soutien social , Allemagne , Projets pilotesRÉSUMÉ
Hyperthermic isolated limb perfusion (HILP) is considered an established treatment for multiple locoregional intransit metastases in malignant melanoma of the extremities. Various mechanisms such as the expression of chemoresistance genes and heat shock proteins by the tumor may be responsible for varying response rates and locoregional recurrences of the treatment. The aim of the experimental animal study was to investigate the direct impact of HILP on such mechanisms of resistance. Tissue temperature, administration of the cytostatic drug, and duration of perfusion were varied. Expression of the chemoresistance genes mdr1, mrp1, mrp2, and lrp and of heat shock protein 72 (HSP72) in the tumor tissue was analysed using RT-PCR and western blot analysis. The untreated SK-MEL-3 tumor expressed mdr1, mrp1, and lrp, but not mrp2. Neither variation of temperature, administration of the cytostatic drug, nor duration of perfusion changed the expression of this "resistance pattern". In contrast to the cytostatic drug, hyperthermia causes a persistent induction of HSP72. Both observations could offer a potential explanation for failure of HILP in malignant melanoma.
RÉSUMÉ
The anatomy and histology of the female reproductive tract of the Indonesian wild pig Babyrousa celebensis was studied by means of reproductive tracts obtained from seven animals aged between two and 22 years of age. The ovary appeared to have the ability to ovulate up to four ova at one time. However, the combined ovarian output seemed to average 1.86 ova. Ovulation can take place at any time from puberty to old age (22 years). The opening to the uterine tube was indicated by a 'flower-like' array of tall, broad epithelial 'petals' arising from the luminal surface of the funnel. The mucosal surfaces of these structures were covered in a mixture of prominent ciliated cells and bulbous secretory cells. The uterine tube followed a tightly convoluted path to the tip of the uterine horn. The uterus was proportionately short. The anatomical construction of the uterus was similar to those of other suids in that the columnar endometrium was heavily folded, there was a rich supply of uterine glands in the lamina propria, and the uterus was provided with a good blood supply. The cervix was thick walled and had a spiral lumen.
Sujet(s)
Système génital de la femme/anatomie et histologie , Suidae/anatomie et histologie , Animaux , Col de l'utérus/anatomie et histologie , Col de l'utérus/ultrastructure , Espèce en voie de disparition , Trompes utérines/anatomie et histologie , Trompes utérines/ultrastructure , Femelle , Fécondité , Système génital de la femme/physiologie , Follicule ovarique/ultrastructure , Ovaire/anatomie et histologie , Ovaire/physiologie , Ovaire/ultrastructure , Suidae/physiologie , Utérus/anatomie et histologie , Utérus/physiologie , Utérus/ultrastructure , Vagin/anatomie et histologie , Vagin/ultrastructure , Vulve/anatomie et histologieRÉSUMÉ
Endogenous prion proteins (PrP) play the central role in the pathogenesis of transmissible spongiform encephalopathies. The carbohydrate N-acetylgalactosamine 4-O sulfotransferase 8 (CHST8) promotes the conversion of the cellular PrP(C) into the pathogenic PrP(d). Six sequence variants within the CHST8 gene were identified by comparative sequencing and genotyped for a sample of 623 animals comprising bovine spongiform encephalopathy (BSE)-affected and healthy control cows representing German Fleckvieh (German Simmental), German Holstein (Holstein-Friesian) and Brown Swiss. Significant differences in the allele, genotype and haplotype frequencies between BSE-affected and healthy cows indicate an association of sequence variant g.37254017G>T with the development of the disease in Brown Swiss cattle.
Sujet(s)
Bovins/génétique , Encéphalopathie spongiforme bovine/génétique , Prédisposition génétique à une maladie , Sulfotransferases/génétique , Animaux , Encéphalopathie spongiforme bovine/métabolisme , Protéines PrPC/métabolisme , Sulfotransferases/métabolisme ,RÉSUMÉ
Scrotal and inguinal hernias are of great economic importance to the pig industry. These lesions are thought to result from incomplete closure of the inguinal ring and/or a patent processus vaginalis. Impairment of programmed cell death (PCD) may be involved in these abnormalities. As tissue Ca(2+) overload may be used as a measure of cell death, the aim of this study was to determine the tissue Ca(2+) content in samples of hernia sac, peritoneum, cremaster muscle and aqueous fluid from newborn piglets with scrotal or inguinal hernias (n=18) or cryptorchidism (n=18). Control samples from healthy piglets (n=20) were also evaluated. Tissue Ca(2+) content was determined by atomic absorption spectrophotometry. Significantly less Ca(2+) was found in the sacs (0.005 mg/g wt), peritoneal tissue (0.100 mg/g wt) and cremaster muscles (0.008 mg/g wt) of piglets with inguinal or scrotal hernias compared with control tissues (0.184, 0.144 and 0.048 mg/g wt for sacs, peritoneal tissue and cremaster muscles, respectively). These findings suggest that there may be perturbation of the apoptotic pathway in the urogenital tissues of affected piglets.
Sujet(s)
Calcium/analyse , Cryptorchidie/métabolisme , Cryptorchidie/médecine vétérinaire , Hernie/métabolisme , Hernie/médecine vétérinaire , Maladies des porcs/métabolisme , Animaux , Hernie/congénital , Mâle , Muscles lisses/métabolisme , Péritoine/métabolisme , Scrotum/anatomopathologie , Suidae , Maladies des porcs/congénitalSujet(s)
Perforation de l'oesophage/traitement médicamenteux , Oesophage/traumatismes , Facteur XIII/usage thérapeutique , Corps étrangers/complications , Cicatrisation de plaie/effets des médicaments et des substances chimiques , Adolescent , Endoscopie digestive , Perforation de l'oesophage/diagnostic , Femelle , Corps étrangers/diagnostic , Humains , Brossage dentaire/instrumentationRÉSUMÉ
BACKGROUND: One of the biological characteristics of melanoma is the locoregional development of metastases that are difficult to treat by conventional tumour mass reduction. Locoregionally metastasised melanoma of the limb can effectively be treated by hyperthermic isolated limb perfusion (HILP). Postoperative complication rates are acceptable. Only few studies have examined long-term complications. This is the reason why we followed up patients in respect of long-term physical and psychological complications after HILP. MATERIALS AND METHODS: 312 patients with melanoma of the limb underwent HILP in our department between 1977 and 1983. Eighty-two patients that were still alive and no older than 80 years at the time of follow-up were contacted and invited to a physical examination. On average, follow-up took place 20 years after HILP. Thirty-nine patients were willing to participate in the study. Twelve of these patients were male and 27 female. The average age was 63.1 years (range 41 to 79). The average age at the point of perfusion was 42.1 years (range 19 to 59). In 10 cases the upper extremity was involved, in 29 patients the lower extremity. Patients were questioned on impairment of daily life and their health status using a standardised questionnaire. A physical examination was performed to document the impairments quantitatively. Ranges of motion, circumference and neurological deficits of the operated limbs were compared to the healthy limbs. RESULTS: At the time of follow-up examination all patients were without recurrent disease. A definite correlation between impairment of the general health condition and the operation could only be found in one patient with persisting lymph oedema. Thirteen patients still wore elastic stockings during the day, 9 of which regularly underwent lymphatic drainage. Most of the patients (58%) saw an improvement of their condition due to the treatment. 67% of the patients reported not having any or only slight impairment of everyday life. Only a few cases had disadvantages in their social and working life due to the perfusion. The physical examination of the upper limb showed an impaired range of motion of the shoulder in all planes in 50% of the patients. Relevant decrease in range of motion in the elbow was seen in two patients. The other examination results showed no significant differences in comparison to the healthy arm. The analysis of the lower limb showed relevant clinical reduction of range of motion in all three major joints. Significant differences were also found in the circumference of the leg compared to the healthy side. SUMMARY: According to our results and results from the literature it was possible to show that hyperthermic isolated limb perfusion is associated with an elevated risk of persisting impairment of range of motion of the treated limb. The impaired function is due to a persistent swelling of the limb because of lymph oedema on the one hand and local toxicity to the ligaments of the joints on the other. Response rates and results of HILP have greatly improved in the last years due to numerous modifications so that this treatment is the method of choice in locoregionally metastasised melanoma of the limb in spite of the long-term complication rate.