[Bone substitution materials in therapy of cystic tumors of the immature skeleton]. / Knochenersatzmaterialien in der Therapie zystischer Tumoren des wachsenden Skeletts.

The primary goal in the treatment of cystic bone tumors in children is the restoration of bone integrity and normal function. It is assumed that filling of the cavity defect after removal of the tumor will facilitate bone healing. In order to reduce the complications observed with autografts and allografts use bone graft substitutes were developed. The current literature review shows that the application of substances with potential immunogenic, toxic or cancerogenic properties should be avoided. Among the purely synthetic mineral materials, tricalcium phosphate has the biochemical properties most compatible with new bone formation and calcium phosphate cements can be used to provide immediate stability in cases of existing or imminent fractures. However, there is currently insufficient evidence that the use of bone grafts or bone graft substitutes provides a real benefit to the patient, especially in comparison with no graft at all. Prospective randomized studies are necessary in order to delineate the indications for bone grafting or use of bone graft substitutes for the treatment of cystic bone tumors in children.

[Persistent dysplasia in preschool children : Dega acetabuloplasty]. / Restdysplasie im Kleinkindesalter : Azetabuloplastik nach Dega.

OBJECTIVE: Restoration of a congruent, stable, mobile hip joint with normal function. INDICATIONS: Persistent acetabular dysplasia of congenital or neuromuscular origin in children with still open triradiate cartillage. CONTRAINDICATIONS: Age under 18 months, closed triradiate cartilage, femoral head deformity. SURGICAL TECHNIQUE: Incomplete supraacetabular transiliac osteotomy, the correction is performed by reshaping the acetabulum taking advantage of the inherent flexibility of the triradiate cartilage and the periacetabular bone. A triangular bioresorbable xenograft is used to maintain the correction until bony healing. POSTOPERATIVE MANAGEMENT: Cast immobilization is not necessary, non-weight bearing for 4 weeks after surgery, then full weight bearing. RESULTS: In all, 31 hips in 20 patients were surgically treated for persistent acetabular dysplasia with the Dega acetabuloplasty. The results were retrospectively studied. The mean age at surgery was 42 months (range 31-67 months). The mean follow-up was 31 months (range 12-60 months). The acetabular angle before surgery measured 31.5° (range 27-44°) and was corrected to 14° (range 8-20°) at last follow-up. All patients showed at last presentation normal hip range of motion and had no complaints. None of the patients had functional restrictions. Severe complications were not observed. Transitory inguinal swelling was observed in only 3 cases in the immediate postoperative period and resolved completely without sequelae.

Combined treatment of congenital pseudarthrosis of the tibia, including recombinant human bone morphogenetic protein-2: a case series.

The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) for the treatment of congenital pseudarthrosis of the tibia has been investigated in only one previous study, with promising results. The aim of this study was to determine whether rhBMP-2 might improve the outcome of this disorder. We reviewed the medical records of five patients with a mean age of 7.4 years (2.3 to 21) with congenital pseudarthrosis of the tibia who had been treated with rhBMP-2 and intramedullary rodding. Ilizarov external fixation was also used in four of these patients. Radiological union of the pseudarthrosis was evident in all of them at a mean of 3.5 months (3.2 to 4) post-operatively. The Ilizarov device was removed after a mean of 4.2 months (3.0 to 5.3). These results indicate that treatment of congenital pseudarthrosis of the tibia using rhBMP-2 in combination with intramedullary stabilisation and Ilizarov external fixation may improve the initial rate of union and reduce the time to union. Further studies with more patients and longer follow-up are necessary to determine whether this surgial procedure may significantly enhance the outcome of congenital pseudarthrosis of the tibia, considering the refracture rate (two of five patients) in this small case series.

Protective efficacy of an aerosol preparation, obtained from Geranium sanguineum L., in experimental influenza infection.

A polyphenol-rich extract from the aerial roots of the medicinal plant Geranium sanguineum L. (PC) protected mice from mortality in the experimental influenza A/Aichi/2/68 (H3N2) virus infection. To provide evidence how a maximum therapeutic benefit can be derived of this preparation, it was inoculated by 6 different routes. It was found that the aerosol application of PC was highly effective. In the dose 5.4 mg/ml, applied according to a prophylactic-therapeutic schedule, the extract exhibited a marked protective effect. The protective index reached the value of 70.1% and the mean survival time was prolonged with 2.9-4.9 days. The lung infectious virus titres and the lung consolidation of virus-infected and PC-treated animals were all reduced in comparison with control. The application of PC according to schedules, excluding the pretreatment of mice, proved that this condition was essential for protection.