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1.
Orthopade ; 49(3): 277-286, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32095865

RESUMO

Due to the increasing number of endoprosthetic joint replacement operations in older patients as well as in patients with severe primary diseases and comorbidities, the number of revision operations is continuously increasing due to infections. The infection of an endoprosthesis represents a complex clinical picture. This article provides a detailed overview of the treatment of periprosthetic infections with a focus on the diagnostic approach and treatment decision-making. A differentiation is made in periprosthetic infections between infections with a mature or immature biofilm on the surface of the implant. Depending on this, different treatment concepts are available. Highly acute infections represent an orthopedic/surgical emergency in artificial as well as in native joints. Low-grade infections play a role particularly in the area of exchange endoprosthetics. The greatest possible success is achieved only by the interplay of a timely diagnosis, sufficient surgical approach and individualized anti-infective treatment.


Assuntos
Artroplastia de Substituição , Infecções Relacionadas à Prótese , Idoso , Humanos , Reoperação
2.
Orthopade ; 49(2): 191-200, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31996949

RESUMO

Joint infections are a great challenge for the treating physicians. Infection of a native joint can result in the rapid destruction of the joint if treatment is inadequate or delayed and is associated with severe life-threatening diseases, such as sepsis. This article presents a detailed overview of the treatment of joint infections of native joints with a focus on the diagnostic approach and treatment decisions. Infections in native joints are caused either endogenously by hematogenic spreading or are caused by exogenous factors. A relevant proportion of joint infections in native joints occur in connection with iatrogenic measures, such as operations, synovial punctures and joint infiltrations. Fundamentally, acute infections represent an orthopedic surgical emergency, which is associated with the necessity for immediate operative measures. The best possible success can only be achieved by an interaction between early diagnosis, an adequate surgical approach and a tailor-made anti-infectious treatment. This is also the case with periprosthetic infections, which will be dealt with in detail in a second article.


Assuntos
Artrite Infecciosa , Articulações , Infecções Relacionadas à Prótese , Sepse , Humanos
3.
J Antimicrob Chemother ; 74(7): 1911-1920, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30993324

RESUMO

BACKGROUND: Cholangitis is a common complication after endoscopic retrograde cholangiography (ERC). OBJECTIVES: To evaluate antimicrobial coatings for biliary plastic stents in relation to efficacy against biliary pathogens, drug release and toxicity. METHODS: Biliary plastic stents were prepared by coating using a polylactide drug carrier. Stent coatings contained 4% (w/w) drug content of Resomer-octenidine (RO), Resomer-octenidine and citrate (ROC), Resomer-triclosan (RT) or Resomer-gentamicin (RG). Drug-release kinetics, antimicrobial efficacies of coated biliary stents against biliary pathogens and biocompatibilities were tested. Antimicrobial efficacy measurements included MIC testing, zone of inhibition (ZOI) assays and log reduction in bacterial suspensions. RESULTS: Continuous drug release was observed in all antimicrobial stent coatings for at least 168 h with an initial peak within the first 24 h. RT-, ROC- and RG-coated stents resulted in the following log reductions in suspensions: Escherichia coli (-0.3, -7.4 and -6.6, respectively); Enterococcus faecalis (-0.05, -6.3 and -3.9, respectively); and Candida albicans (-0.04, -1.5 and -0.2, respectively). ROC had the highest log reduction in suspension and the most favourable time course of ZOI (≥2 mm, over 72 h) against all tested pathogens. Although RT coatings showed the lowest MICs, they had the lowest ZOIs after 24 h. Concerning RO, acceptable biocompatibility could only be reached by adding a citrate component. RG showed the largest ZOI after 24 h against E. coli (19.3 mm) and E. faecalis (5.1 mm), whereas the ZOI was lower against C. albicans (1.3 mm) compared with ROC (3.7 mm). CONCLUSIONS: ROC corresponds most closely to the requirements of an ideal antimicrobial stent coating to prevent post-ERC cholangitis, showing the highest log reduction in pathogen counts, the most favourable time course of ZOI and high biocompatibility.


Assuntos
Antibacterianos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangite/etiologia , Colangite/prevenção & controle , Stents Farmacológicos , Plásticos , Poliésteres , Antibacterianos/química , Colangiopancreatografia Retrógrada Endoscópica/métodos , Liberação Controlada de Fármacos , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Poliésteres/química , Curva ROC
4.
Int Orthop ; 42(2): 265-271, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29243060

RESUMO

INTRODUCTION: The two-stage revision protocol is the gold standard for controlling and treating low-grade prosthetic joint infections of total hip and total knee arthroplasty. The antibiotic pause for diagnostic reasons before reconstruction (stage two) is discussed in relation to the persistence of the infection and the development of resistant bacterial strains. Serological markers and a synovial analysis are commonly used to exclude the persistence of infection. Therefore, we asked (1) is the serological testing of C-reactive protein and leucocytes a valuable tool to predict a persistence of infection? and (2) what is the role of synovial aspiration of Plymethylmethacrylat (PMMA) spacers in hip and knee joints? MATERIALS AND METHODS: One hundred twelve patients who were MSIS criteria-positive for a prosthetic joint infection were studied, including 45 total hip arthroplasties (THA) and 67 total knee artrhoplasties (TKA) patients. All patients were treated with a two-stage-protocol using a mobile PMMA spacer after a 14-day antibiotic-free interval, during which we measured serological markers (C-reactive protein and leucocytes) and performed synovial aspiration (white blood cell count, polymorphonuclear cell percentage, and microbiological culture) in these patients and compared the results with those of their long-term-follow-up (mean follow-up 27 months, range 24-36 months). RESULTS: Of the 112 patients, 89 patients (79.5%; 95% CI 72-86.9) exhibited infection control after a two-stage exchange, and we detected most methicillin-resistant, coagulase-negative Staphylococci (CoNS) in cases of a persistent infection. The mean sensitivity of serum C-reactive protein in the patients was 0.43 (range 0.23-0.64), and the mean specificity was 0.73 (range 0.64-0.82). For serum leucocytes, the mean sensitivity was 0.09 (range 0-0.29), and the mean specificity was 0.81 (range 0.7-0.92). The mean sensitivity for the WBC count in the synovial fluid (PMMA spacer aspiration) was 0.1 (range 0-0.29), and the mean specificity was 0.79 (range 0.68-0.92). For the PMN percentage, the mean sensitivity was 0.1 (range 0-0.29), and the mean specificity was 0.79 (range 0.68-0.92). No cut-off values could be established for C-reactive protein, leucocytes, WBC count and PMN percentage due to the low AUC. CONCLUSION: No reliable markers were identified for the long-term persistence of infection. C-reactive protein and leucocytes were often elevated, even when the infection was controlled. In addition, normalized serum markers did not exclude the persistence of infection during follow-up. The synovial analysis of the WBC count and PMN percentage did not predict the persistence of infection. However, microbiological synovial fluid analysis is often misleading due to false positive microbiological cultures, which results in overtreatment.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Proteína C-Reativa/análise , Contagem de Leucócitos/métodos , Infecções Relacionadas à Prótese/diagnóstico , Reoperação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Biomarcadores/sangue , Feminino , Seguimentos , Articulação do Quadril/microbiologia , Articulação do Quadril/cirurgia , Humanos , Prótese Articular/efeitos adversos , Articulação do Joelho/microbiologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/cirurgia , Reoperação/efeitos adversos , Estudos Retrospectivos , Sensibilidade e Especificidade , Líquido Sinovial/citologia , Líquido Sinovial/microbiologia
5.
BMC Cancer ; 17(1): 410, 2017 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-28606068

RESUMO

BACKGROUND: Soft tissue sarcomas are rare entities with over 50 histological subtypes. Liposarcoma (LS) is the most common neoplasm in this group; it is a complex neoplasm that is divided into different histological subtypes. Different therapy options, such as surgical resection, radiation, and chemotherapy, are available. Depending on the subtype, location, status of the resection margins and metastatic status, different therapy options are used. Therefore, the aim of this study was to determine the prognostic factors influencing the survival of patients affected by LS with consideration for the grading, histological subtype, state of the resection margin, size, location, metastases and local recurrence in a retrospective, single-centre analysis over 15 years. METHODS: We included 133 patients (male/female = 67/66) in this study. We recorded the histologic subtype, grade, TNM classification, localization, biopsy technique, tumour margins, number of operations, complications, radiation and dose, chemotherapy, survival, recrudescence, metastases and follow-up. Survivorship analysis was performed. RESULTS: We detected 56 (43%; 95%-CI 34.6-51.6%) atypical LS cases, 21 (16.2%; 95%-CI 9.8-22.5) dedifferentiated LS cases, 40 (30.8%; 95%-CI 22.8-38.7) myxoid LS cases and 12 (9.2%; 95%-CI 4.3-14.2) pleomorphic LS cases. G1 was the most common grade, which was followed by G3. Negative margins (R0) were detected in 67 cases (53.6%; 95%-CI 44.9-62.3) after surgical resection. Local recurrence was detected in 23.6% of cases. The presence of metastases and dedifferentiated LS subtype as well as negative margins, grade and tumour size are significant prognostic factors of the survival rates (p < 0.015). CONCLUSION: Grading, LS subtype, negative margins after surgery, metastases and tumour size are independently associated with disease-specific survival, and patients with local recurrence had lower survival rates. We hope our investigation may facilitate a further prospective study and clinical decision-making in LS.


Assuntos
Lipossarcoma Mixoide/terapia , Recidiva Local de Neoplasia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Lipossarcoma Mixoide/patologia , Lipossarcoma Mixoide/secundário , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
6.
BMC Musculoskelet Disord ; 18(1): 206, 2017 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-28532493

RESUMO

BACKGROUND: The aim of this study was to compare the functional outcomes and complication rates after distal femoral replacement (DFR) performed with the modular Munich-Luebeck (MML) modular prosthesis (ESKA/Orthodynamics, Luebeck, Germany) in patients being treated for malignant disease or failed total knee arthroplasty. METHODS: A retrospective review of patient charts and a functional investigation (involving Musculoskeletal Tumor Society Score [MSTS], American Knee Society Score [AKSS], Oxford Knee Score [OKS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Toronto Extremity Salvage Score [TESS], the 12-Item Short-Form [SF-12] Health Survey, and a failure classification system developed by Henderson et al.) of DFR cases from 2002 to 2015 were conducted. The indications for DFR were malignant tumor resection in the femur (n = 20, group A) or failure of revision total knee arthroplasty without a history of malignant disease (n = 16, group B). RESULTS: One-hundred and twenty-nine patients were treated during the study period. Of these, 82 were analyzed for complications and implant-survival. Further, 36 patients were available for functional assessment after a mean follow-up of 86 months (range: 24-154). There were 75 complications in total. The overall failure rate for DFR was 64.6% (53/82 patients). The most common failure mechanisms were type III (mechanical failure), followed by type I (soft tissue) and type II (aseptic loosening). The mean MSTS score (out of 30) was 17 for group A and 12 for group B. All the clinical outcome scores revealed an age-dependent deterioration of function. CONCLUSION: DFR is an established procedure to restore distal femoral integrity. However, complication rates are high. Post-procedure functionality depends mainly on the patient's age at initial reconstruction.


Assuntos
Artroplastia do Joelho/métodos , Artroplastia do Joelho/tendências , Neoplasias Femorais/cirurgia , Prótese de Quadril/tendências , Falha de Prótese/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias Femorais/diagnóstico , Neoplasias Femorais/epidemiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese/métodos , Estudos Retrospectivos , Fatores de Tempo
7.
BMC Complement Altern Med ; 16(1): 313, 2016 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-27562075

RESUMO

BACKGROUND: Glucosamine, a common dietary supplement, has a possible anti-sarcoma effect. However, an understanding of the underlying mechanism of such an effect is limited. For this study we hypothesized that glucosamine suppresses the basal level of matrix metalloproteinase expression in human osteosarcoma cell lines. METHODS: We examined the osteosarcoma cell lines, MG-63 and SaOS-2. Cells were exposed to 0, 10, 50 and 100 µg/ml glucosamine sulfate for 48 h and treatment toxicity was determined through measurement of cell viability and proliferation. Relative gene expression of matrix metalloproteinase (MMP)-2, -3 and -9 was quantified by real-time polymerase chain reaction. Protein levels of MMP-2 and -9 were assessed by ELISA. RESULTS: Administration of 10, 50 or 100 µg/ml glucosamine sulfate had no effect on the cell viability of MG-63 and SaOS-2 cells. A significant reduction of MMP expression in both cell lines was observed only for MMP-3, while a decrease in MMP-9 was seen in SaOS-2 cells. The expression of MMP-2 was not significantly affected in either cell line. Protein level of MMP-3 was reduced in both cell lines upon stimulation with 10 µg/ml glucosamine sulfate whereas for MMP-9 a decrease could only be observed in SaOS-2 cells. CONCLUSION: In this study, we found a pronounced suppressive effect of glucosamine sulfate particularly on MMP-3 and also MMP-9 mRNA and protein levels in osteosarcoma cell lines in vitro. The data warrants further investigations into the potential anti-tumor efficacy of glucosamine sulfate in osteosarcoma.


Assuntos
Expressão Gênica/efeitos dos fármacos , Glucosamina/farmacologia , Metaloproteinase 3 da Matriz/metabolismo , Osteossarcoma/metabolismo , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Humanos , Metaloproteinase 3 da Matriz/análise , Metaloproteinase 3 da Matriz/genética , Metaloproteinase 9 da Matriz/análise , Metaloproteinase 9 da Matriz/genética , Metaloproteinase 9 da Matriz/metabolismo
8.
BMC Musculoskelet Disord ; 16: 220, 2015 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-26296652

RESUMO

BACKGROUND: Medial tibial stress syndrome is one of the most common causes of exertional leg pain in runners whereas musculoskeletal tumors and tumor-like lesions are rare encounters in orthopedic sports medicine practice. Unicameral (simple) bone cyst is a well-known tumor-like lesions of the bone typically affecting children and adolescents. Bilateral occurrence is very rare though and has never been reported before in both tibiae. Failing to accurately diagnose a tumorous lesion can entail far-reaching consequences for both patients and physicians. CASE PRESENTATION: We report the case of large bilateral unicameral bone cysts of the diaphyseal tibiae mimicking medial tibial stress syndrome in a 17-year old professional athlete. This is the first report of symmetric tibial unicameral bone cysts in the literature. The patient complained about persisting shin splint-like symptoms over 5 months despite comprehensive conservative treatment before MRI revealed extensive osteolytic bone lesions in both diaphyseal tibiae. The patient-tailored, less-invasive surgical procedure, allowing the patient to return to his competitive sports level symptom-free 3 months after surgery and to eventually qualify for this years Biathlon Junior World Championships, is outlined briefly. Pathogenesis and various treatment options for this entity will be discussed. CONCLUSION: This report will help to raise awareness for musculoskeletal tumors as differential diagnosis for therapy-refractory symptoms in young athletes and encourage medical staff involved in sports medicine and athlete support to perform early high quality imaging and initiate sufficient surgical treatment in similar cases. Moreover, our less-invasive surgical procedure aiming for a fast return to sports might be an optimal compromise between traditional open curettage with low risk of recurrence and a soft tissue-saving and bone-sparing minimal-invasive technique.


Assuntos
Atletas , Cistos Ósseos/diagnóstico , Erros de Diagnóstico , Síndrome do Estresse Tibial Medial/diagnóstico , Tíbia/cirurgia , Adolescente , Cistos Ósseos/cirurgia , Diáfises/patologia , Diáfises/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Recuperação de Função Fisiológica , Corrida , Tíbia/patologia
9.
Front Immunol ; 15: 1355824, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38799447

RESUMO

Objectives: IL26 levels are elevated in the blood and synovial fluid of patients with inflammatory arthritis. IL26 can be produced by Th17 cells and locally within joints by tissue-resident cells. IL26 induces osteoblast mineralization in vitro. As osteoproliferation and Th17 cells are important factors in the pathogenesis of axial spondyloarthritis (axSpA), we aimed to clarify the cellular sources of IL26 in spondyloarthritis. Methods: Serum, peripheral blood mononuclear cells (n = 15-35) and synovial tissue (n = 3-9) of adult patients with axSpA, psoriatic arthritis (PsA) and rheumatoid arthritis (RA) and healthy controls (HCs, n = 5) were evaluated by ELISA, flow cytometry including PrimeFlow assay, immunohistochemistry and immunofluorescence and quantitative PCR. Results: Synovial tissue of axSpA patients shows significantly more IL26-positive cells than that of HCs (p < 0.01), but numbers are also elevated in PsA and RA patients. Immunofluorescence shows co-localization of IL26 with CD68, but not with CD3, SMA, CD163, cadherin-11, or CD90. IL26 is elevated in the serum of RA and PsA (but not axSpA) patients compared with HCs (p < 0.001 and p < 0.01). However, peripheral blood CD4+ T cells from axSpA and PsA patients show higher positivity for IL26 in the PrimeFlow assay compared with HCs. CD4+ memory T cells from axSpA patients produce more IL26 under Th17-favoring conditions (IL-1ß and IL-23) than cells from PsA and RA patients or HCs. Conclusion: IL26 production is increased in the synovial tissue of SpA and can be localized to CD68+ macrophage-like synoviocytes, whereas circulating IL26+ Th17 cells are only modestly enriched. Considering the osteoproliferative properties of IL26, this offers new therapeutic options independent of Th17 pathways.


Assuntos
Antígenos CD , Artrite Psoriásica , Interleucinas , Sinoviócitos , Humanos , Artrite Psoriásica/imunologia , Artrite Psoriásica/metabolismo , Sinoviócitos/metabolismo , Sinoviócitos/imunologia , Sinoviócitos/patologia , Masculino , Adulto , Feminino , Antígenos CD/metabolismo , Interleucinas/metabolismo , Interleucinas/sangue , Pessoa de Meia-Idade , Antígenos de Diferenciação Mielomonocítica/metabolismo , Espondiloartrite Axial/imunologia , Células Th17/imunologia , Células Th17/metabolismo , Membrana Sinovial/imunologia , Membrana Sinovial/metabolismo , Membrana Sinovial/patologia , Articulações/patologia , Articulações/imunologia , Articulações/metabolismo , Artrite Reumatoide/imunologia , Artrite Reumatoide/metabolismo , Artrite Reumatoide/sangue , Artrite Reumatoide/patologia
10.
World J Surg Oncol ; 11: 241, 2013 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-24066980

RESUMO

Both giant synovial osteochondroma and parosteal osteosarcoma are rare musculo-skeletal tumors, often localized in the vicinity of the knee. Misdiagnosis of a malignant bone tumor can entail fatal consequences. Etiology of giant synovial osteochondroma is widely unsolved but is believed to originate from synovial chondromatosis, a mostly benign metaplasia of the synovial membrane. Parosteal osteosarcoma is a low-grade surface osteosarcoma with a propensity of local recurrence and the potential of distant metastasis and therefore requiring a different therapeutical approach. We report the case of a popliteal giant osteochondroma mimicking a parosteal osteosarcoma. Relevant facts of this rare entity regarding pathogenesis, treatment, and differential diagnoses will be discussed.


Assuntos
Neoplasias Ósseas/diagnóstico , Osteocondroma/diagnóstico , Osteossarcoma/diagnóstico , Cisto Popliteal/patologia , Membrana Sinovial/patologia , Adulto , Neoplasias Ósseas/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Osteocondroma/cirurgia , Osteossarcoma/cirurgia , Cisto Popliteal/cirurgia , Prognóstico , Sinovectomia
11.
Surg Infect (Larchmt) ; 23(2): 105-112, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34762545

RESUMO

Background: Institutional programs such as antibiotic stewardship (ABS) programs offer possibilities to monitor and modify antibiotic usage with the aim of reducing antibiotic resistance. In orthopedic units that treat peri-prosthetic joint infections (PJIs), ABS programs are still rare, however, there is extensive use of high-risk antibiotic agents and an increased risk for the occurrence of Clostridium difficile infections (CDIs). Patients and Methods: An ABS program was implemented at the Department of Orthopedic Surgery at a university hospital. Quarterly antibiotic consumption was measured in defined daily doses (DDDs) per 100 patient-days (PDs) at 10 quarters before the intervention and seven quarters after the intervention. The effect of the new antibiotic policy on drug use rates was evaluated using an interrupted time-series analysis. Estimated changes over time in the incidence of CDIs (cases per 1,000 PDs) were analyzed. Results: A remarkable percentual reduction in second-generation cephalosporin use of 83% (p < 0.001; pre-intervention level, 81.486 DDDs/100 patient-days; post-intervention level, 13.751 DDDs/100 PDs) and clindamycin administration of 78% (p < 0.001; pre-intervention level, 18.982 DDDs/100 PDs; post-intervention level, 4.216 DDDs/100 PDs) was observed after implementation of ABS interventions. Total antibiotic use declined by 25% (p < 0.001; pre-intervention level, 129.078 DDDs/100 PDs; post-intervention level, 96.826 DDDs/100 PDs). Conclusions: This research assessed the positive impact of an intensified ABS program at an orthopedic department specializing in PJIs. Antibiotic stewardship program interventions encourage the reduction of total antibiotic usage and especially high-risk antibiotic agents, associated with the development of antimicrobial resistance.


Assuntos
Gestão de Antimicrobianos , Infecções por Clostridium , Procedimentos Ortopédicos , Antibacterianos/uso terapêutico , Infecções por Clostridium/epidemiologia , Hospitais Universitários , Humanos , Procedimentos Ortopédicos/efeitos adversos
17.
Surg Infect (Larchmt) ; 21(10): 877-883, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32282286

RESUMO

Background: Peri-prosthetic joint infection (PJI) is a major complication of knee arthroplasty that can cause long-term disability. In addition to its physical impact, there is a clear psychological burden that has not been measured yet. We hypothesized that the psychosocial burden of PJI can be assessed quantitatively using standardized questionnaires and may be correlated with treatment stage. Methods: Thirty-one patients were enrolled in this longitudinal prospective cohort study from August 2015 to November 2016. Participants had clinically established knee PJI after primary total knee replacement in osteoarthritis according to the Musculoskeletal Infection Society criteria and underwent a standardized two-stage protocol. After explantation of the prosthesis and implantation of a polymethylmethacrylate knee spacer, patients were treated with organism-specific intravenous antibiotics for two weeks, followed by oral antibiotics for four weeks; and then reimplantation was performed in all cases. Psychometrically validated standardized questionnaires were used to measure psychosocial stress via self-assessment at four time points: (1) Before explantation of the prosthesis; (2) after explantation; (3) after the antibiotic treatment before reimplantation; and (4) three months after reimplantation (follow-up). The Patient Health Questionnaire (PHQ)-4, Short Form (SF)-12 (including PSK and KSK), Questions about Life Satisfaction (FLZM) and Fear of Progression (PA-F-KF) (titles and abbreviations in German) scores were interpreted according to cut-off values for depression, fear of progression, anxiety, and quality of life. Results: Eighteen patients (58.1%) showed a PHQ-4 score above the cut-off value for depression at least once, with the highest score before reimplantation (time point 3). On the SF-12, the mean subtest mental scale (PSK) score was 42.6 (± 14.5), and the mean subtest physical scale (KSK) score was 26.9 (± 7.5) over the four time points, which was significantly lower than that of the general German population (PSK 53.1, KSK 44.0; p < 0.05). The SF-12 scores did not change significantly over time. On the FLZ, health was least satisfactory, followed by recreational activities and work. On the PA-F-KF, patients had the greatest fear of being dependent on outside help, drastic medical interventions, and infection progression. The mean PA-F-KF value was 31.24 (± 9.60; values ≥34 are regarded as critical). Conclusion: Peri-prosthetic joint infection is a measurable, relevant psychosocial stressor for patients. Their quality of life and fear of the disease progressing are comparable to those of oncology patients. Routine screening should be conducted to identify affected patients early for appropriate treatment, improving long-term outcomes. Orthopaedic surgeons who treat patients with PJI should initiate by psychologists as well in order to maintain the patient's long-term quality of life.


Assuntos
Prótese do Joelho , Infecções Relacionadas à Prótese , Angústia Psicológica , Humanos , Articulação do Joelho , Prótese do Joelho/efeitos adversos , Estudos Prospectivos , Próteses e Implantes , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/cirurgia , Qualidade de Vida , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
18.
Anticancer Res ; 40(10): 5793-5800, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988907

RESUMO

BACKGROUND/AIM: Myxofibrosarcoma (MFS) is characterized by an infiltrative growth pattern. This study aimed to determine the correlation between overall survival (OS) and morphological features of MFS as well as examine the reproducibility of these findings on preoperative magnetic resonance imaging (MRI). PATIENTS AND METHODS: Fifty-eight MFS patients underwent preoperative MR imaging with the following features analysed: i) tumour size, ii) localization, iii) margins, iv) morphology, v) signal characteristics, vi) contrast enhancement, vii) presence and extent of perilesional oedema, and viii) presence of the tail sign. RESULTS: Only circumscribed perilesional oedema was associated with a significantly better survival compared to diffuse oedema (p=0.010), which was found in the majority of cases. The tail sign was found in less than 50% of the cases. Cohen's kappa coefficients confirmed a relatively high interrater variability. CONCLUSION: Perilesional diffuse oedema on MR imaging of MFS is significantly correlated with a poor overall survival. The interrater variability in interpretation of MR examinations varies from slight to substantial agreement. Preoperative MR imaging with detailed planning of the resection seem to be a logical approach to achieve negative resection margins and recurrence-free survival.


Assuntos
Fibrossarcoma/diagnóstico por imagem , Histiocitoma Fibroso Maligno/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Fibrossarcoma/fisiopatologia , Histiocitoma Fibroso Maligno/fisiopatologia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/fisiopatologia , Cuidados Pré-Operatórios , Prognóstico , Neoplasias de Tecidos Moles/fisiopatologia
19.
Anticancer Res ; 39(6): 2985-2992, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177139

RESUMO

BACKGROUND: Soft-tissue sarcomas are rare entities that are divided into approximately 50 histological subtypes. Myxofibrosarcoma (MFS) represents approximately 20% of all soft-tissue sarcomas, especially in elderly patients in their sixth to eighth decades of life. The treatment for soft-tissue sarcomas varies from primary surgical resection to neoadjuvant or adjuvant radiotherapy or cytotoxic chemotherapy. The aim of this study was to evaluate the prognostic factors affecting survival of patients with MFS, taking into account gender, tumour grade, state of the resection margin, local recurrence, use of radiotherapy, presence of metastases and blood levels of haemoglobin and C-reactive protein in a retrospective, single-centre analysis with a minimum follow-up period of 60 months (range=60-156 months). PATIENTS AND METHODS: The study included 34 patients (male/female=20/14). Tumour localization, tumour grade, tumour margins, local recurrence, the use of radiotherapy, the presence of metastasis, and the blood levels of haemoglobin and C-reactive protein preoperatively and during follow-up were evaluated. RESULTS: MFS constituted the most common high-grade sarcoma (G2/G3, 79.4%) in our cohort and was generally located in a lower limb (73.6%). Negative margins (R0) were detected in 67.6% of patients after surgical resection, and local recurrence occurred in 23.5% of all patients after a mean disease-free period of 19.4 months. Both parameters exerted no significant influence on survival. Radiotherapy was performed in a neoadjuvant or an adjuvant setting in 50% of patients (eight neoadjuvant, nine adjuvant). Metastasis occurred after a mean of 20.4 months in 38.2% of the patients. Higher C-reactive protein levels showed a trend towards being associated with worse survival, but the association was not significant (p=0.084); haemoglobin level had no influence on the survival rate (p=0.426). Tumour grade and metastasis were significant prognostic factors of survival (log-rank test p=0.041 and p=0.00007). Ten patients (29.4%) died due to MFS during our follow-up period. CONCLUSION: The tumour grade and metastasis of MFS are independently associated with disease-specific survival, whereas negative surgical margins, local recurrence and blood levels of C-reactive protein and haemoglobin were not significant prognostic factors. The understanding of the molecular biological patterns that result in the metastasis of these tumours will help develop better treatment plans in the future.


Assuntos
Proteína C-Reativa/metabolismo , Fibrossarcoma/patologia , Fibrossarcoma/terapia , Hemoglobinas/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Estudos de Coortes , Feminino , Fibrossarcoma/metabolismo , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Terapia Neoadjuvante , Prognóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Análise de Sobrevida , Taxa de Sobrevida
20.
Anticancer Res ; 39(6): 3159-3165, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177162

RESUMO

BACKGROUND: Patients with sarcoma are particularly vulnerable to psychosocial distress. The aim of this study was to collect preliminary data on the prevalence of psychosocial distress in such patients during follow-up care and identify risk factors associated with higher psycho-oncological stress levels. PATIENTS AND METHODS: The study retrospectively enrolled 202 patients with bone or soft-tissue sarcomas who underwent routine psychosocial distress screening during their follow-up care. All patients were screened using an electronic cancer-specific questionnaire. RESULTS: Females and patients who underwent radiotherapy were more distressed. Psychosocial distress levels were markedly higher in the early postoperative phase, but approximately one-third of patients showed high psychosocial distress levels even more than 2 years postoperatively. CONCLUSION: The results underscore the importance of routine psychosocial distress screenings in patients with sarcoma, which should be performed throughout the follow-up period.


Assuntos
Assistência ao Convalescente/psicologia , Neoplasias Ósseas/terapia , Saúde Mental , Osteossarcoma/terapia , Sarcoma/terapia , Neoplasias de Tecidos Moles/terapia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários , Adaptação Psicológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/psicologia , Efeitos Psicossociais da Doença , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteossarcoma/diagnóstico , Osteossarcoma/psicologia , Valor Preditivo dos Testes , Dados Preliminares , Prevalência , Estudos Retrospectivos , Fatores de Risco , Sarcoma/diagnóstico , Sarcoma/psicologia , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/psicologia , Estresse Psicológico/diagnóstico , Fatores de Tempo , Adulto Jovem
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