Gerald Gruber - Academia.edu (original) (raw)

Papers by Gerald Gruber

Anz J Surg, 2009

Interdisciplinary resection of a giant retroperitoneal liposarcoma of 25 kga ns_5160 957..964 Fig... more Interdisciplinary resection of a giant retroperitoneal liposarcoma of 25 kga ns_5160 957..964 Fig. 1. the marginal resection of an fatty intraabdominal mass, 25 kg of weight.

Der Orthopade, May 1, 2009

Das Knochenskelett ist nach Lunge und Leber die dritthäufigste Lokalisation von metastatischen Ab... more Das Knochenskelett ist nach Lunge und Leber die dritthäufigste Lokalisation von metastatischen Absiedelungen [30]. Eine besonders hohe Inzidenz für Skelettmetastasen konnte bei Mamma-, Prostata-, Bronchus-, Nieren-und Schildrüsenkarzinom nachgewiesen werden [15]. Pathologische Frakturen wurden vorwiegend bei osteolytischen Adenokarzinommetastasen der Lunge, Mamma, Niere, Schilddrüse und des Gastrointestinaltraktes beobachtet [1, 3]. Nach der Wirbelsäule und dem Becken treten Knochenmetastasen am häufigsten an den Extremitäten auf. Die proximalen gut durchbluteten Enden des Femurs und Humerus sind häufiger als alle anderen langen Röhrenknochen des Extremitätenskeletts von Karzinommetastasen bzw. pathologischen Frakturen betroffen [21, 27].

European Spine Journal Official Publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cervical Spine Research Society, Sep 12, 2008

Predicting prognosis is the key factor in selecting the proper treatment modality for patients wi... more Predicting prognosis is the key factor in selecting the proper treatment modality for patients with spinal metastases. Therefore, various assessment systems have been designed in order to provide a basis for deciding the course of treatment. Such systems have been proposed by Tokuhashi, Sioutos, Tomita, Van der Linden, and Bauer. The scores differ greatly in the kind of parameters assessed. The aim of this study was to evaluate the prognostic value of each score. Eight parameters were assessed for 69 patients (37 male, 32 female): location, general condition, number of extraspinal bone metastases, number of spinal metastases, visceral metastases, primary tumour, severity of spinal cord palsy, and pathological fracture. Scores according to Tokuhashi (original and revised), Sioutos, Tomita, Van der Linden, and Bauer were assessed as well as a modified Bauer score without scoring for pathologic fracture. Nineteen patients were still alive as of September 2006 with a minimum follow-up of 12 months. All other patients died after a mean period of 17 months after operation. The mean overall survival period was only 3 months for lung cancer, followed by prostate (7 months), kidney (23 months), breast (35 months), and multiple myeloma (51 months). At univariate survival analysis, primary tumour and visceral metastases were significant parameters, while Karnofsky score was only significant in the group including myeloma patients. In multivariate analysis of all seven parameters assessed, primary tumour and visceral metastases were the only significant parameters. Of all seven scoring systems, the original Bauer score and a Bauer score without scoring for pathologic fracture had the best association with survival (P \ 0.001). The data of the present study emphasize that the original Bauer score and a modified Bauer score without scoring for pathologic fracture seem to be practicable and highly predictive preoperative scoring systems for patients with spinal metastases. However, decision for or against surgery should never be based alone on a prognostic score but should take symptoms like pain or neurological compromise into account.

Journal of orthopaedic research : official publication of the Orthopaedic Research Society, Jan 15, 2016

Osteoarthritis (OA) of the hand is a common disease resulting in pain and impaired function. The ... more Osteoarthritis (OA) of the hand is a common disease resulting in pain and impaired function. The pathogenesis of hand OA (HOA) is elusive and models to study it have not been described. Chondrocyte culture has been essential to understand cartilage degeneration, which is a hallmark of OA. We investigated the feasibility of human chondrocyte culture derived from proximal interphalangeal (PIP) finger joints. Hyaline cartilage of the PIP and knee joints was obtained from human cadavers. Chondrocytes harvested up to 236 hours after death of the donors were viable and expressed chondrocyte-specific genes. Gene expression comparing chondrocytes from PIP and knee joints using Affymetrix GeneChip arrays resulted in a unique PIP-specific gene expression pattern. Genes involved in developmental processes including the WNT pathway were differentially expressed between the joints. These findings suggest that our knowledge on chondrocyte biology derived mainly from knee and hip joints may not ap...

Arch Orthop Traum Surg, 2006

Most fractures of the distal radius can be treated by conservative means; however, unstable dista... more Most fractures of the distal radius can be treated by conservative means; however, unstable distal radius fractures (DRFs) require surgical fixation. The purpose of this study was to evaluate functional and radiographic results of DRFs treated with a palmar plating system regarding patient's quality of life. This study reports a total number of 104 DRFs in 102 patients, operatively treated, over a 2-year period with a mean follow up time of 15.6 +/- 7.2 months The patient's average age was 59.9 +/- 18.0 years. The results were evaluated according to the scores of Gartland and Werley, Castaing and the disabilities of the arm, shoulder, and hand (DASH) outcome questionnaire. Ninety-three patients were evaluated at final examination. Excellent and good results were achieved for 92 (98.9%) patients according to score of Gartland and Werley and for 86 (92.5%) patients regarding the scoring system of Castaing. The DASH outcome questionnaire averaged 8.0 +/- 13.7 points. This study shows, in a representative number of cases, that palmar plating of unstable fractures of the distal radius is a safe and effective treatment modality. Early surgical treatment results in optimal outcome regarding patient's quality of life.

European Surgery, Aug 1, 2009

ABSTRACT BACKGROUND: Soft-tissue sarcomas (STS) of the extremities are frequently misdiagnosed at... more ABSTRACT BACKGROUND: Soft-tissue sarcomas (STS) of the extremities are frequently misdiagnosed at initial presentation with a high rate of treatment not in accordance with clinical practice guidelines. The purpose of this study was to detect clinical influence of inadequate surgery prior to referral to a tumour centre. METHODS: Five-year single institution review of patients operated for STS of the extremities in a tertiary referral unit. RESULTS: A total of 116 patients underwent curative surgery for STS between 1998 and 2003. A total of 59 (51%) patients were operated contrary to current clinical guidelines before referral (group B). A total of 54 (92%) of these patients were operated without previous biopsy. Group B had a significantly higher rate of intralesional margins (p < 0.001), a smaller diameter of primary lesion (p = 0.007), a higher rate of additional plastic surgery after re-resection (p = 0.009) and a longer period before referral (p < 0.001) than patients treated according to treatment guidelines (group A). There was no influence on survival, local recurrence or metastasis. CONCLUSIONS: There is a need for the reduction of inadequate surgery for STS. GRUNDLAGEN: Weichteilsarkome (WTSA) sind seltene mesenchymale Tumore des Stütz- und Bewegungsapparates mit einer hohen Inzidenz an primären Fehldiagnosen und Therapie außerhalb bestehender Richtlinien. Im Zuge dieser retrospektiven Kohortenanalyse wurde der Einfluss von primär inadäquater chirurgischer Therapie vor Transferierung an ein Tumorzentrum analysiert. METHODIK: Prospektiv geplante Fünfjahresbeobachtung an einem tertiären Zentrum für Tumore des Stütz- und Bewegungsapparates. ERGEBNISSE: 116 Patienten wurden im Zeitraum zwischen 1998 und 2003 wegen eines WTSA operiert. 59 (51 %) Patienten(d) wurden vor ihrer Transferierung andernorts inadäquat chirurgisch behandelt. 54 (92 %) Patienten von diesen wurden ohne vorangegangene Biopsie operiert und zeigten eine signifikant höhere Rate an intraläsionalen Resektionsgrenzen (p < 0,0001), einen geringeren mittleren Tumordurchmesser (p = 0,007), eine höhere Rate an plastisch chirurgischen Deckungen bei erfolgter Definitivresektion (p = 0,009) und einen längeren mittleren Zeitraum bis zur Zuweisung an ein Zentrum (p < 0,0001) als Patienten, die primär adäquat chirurgisch behandelt wurden. Es war kein Einfluss auf Überleben, Lokalrezidivrate oder Metastasierungsrate erkennbar. SCHLUSSFOLGERUNGEN: Es besteht die Notwendigkeit zur Reduktion inadäquater chirurgischer Therapie von Patienten mit Weichteilsarkomen.

Transactions of the New York Academy of Sciences, Jun 1, 1968

Canadian journal of surgery. Journal canadien de chirurgie

Journal of orthopaedic research : official publication of the Orthopaedic Research Society, Jan 21, 2015

Formation of chondrocyte clusters is not only a morphological sign of osteoarthritis but it is al... more Formation of chondrocyte clusters is not only a morphological sign of osteoarthritis but it is also observed in cell culture. Active locomotion of chondrocytes is controlled by integrins in vitro. Integrins bind to Laminin-A4 (LAMA4), a protein that is highly expressed in vivo in clusters of hypertrophic chondrocytes. We tested if LAMA4 is relevant for cluster formation. Human chondrocytes were cultured in a 2D matrigel model and treated with different concentrations of a monoclonal inhibitory anti-LAMA4-antibody. Migration and cluster formation was analysed using live cell imaging technique. Full genome gene expression analysis was performed to assess the effect of LAMA4 inhibition. The data set were screened for genes relevant to cell motility. F-actin staining was performed to document cytoskeletal changes. Anti-LAMA4 treatment significantly reduced the rate of cluster formation in human chondrocytes. Cells changed their surface morphology and exhibited fewer protrusions. Express...

Canadian journal of surgery. Journal canadien de chirurgie, 2008

Journal of Orthopaedic Research, 2014

The development of osteoarthritis (OA) depends on genetic and environmental factors, which influe... more The development of osteoarthritis (OA) depends on genetic and environmental factors, which influence the biology of the chondrocyte via epigenetic regulation. Changes within the epigenome might lead the way to discovery of new pathogenetic pathways. We performed a genome-wide methylation screening to identify potential differences between paired mild and severe osteoarthritic human cartilage. Sixteen female patients suffering from OA underwent total knee joint replacement. Cartilage specimens collected from corresponding macroscopically undamaged and from damaged areas were processed for DNA extraction and histology to evaluate the histological grading of the disease. Paired specimens were analysed for the methylation status of the whole genome using human promoter microarrays (Agilent, Santa Clara, CA). Selected target genes were then validated via methylation-specific qPCR. One thousand two hundred and fourteen genetic targets were identified differentially methylated between mild and severe OA. One thousand and seventy of these targets were found hypermethylated and 144 hypomethylated. The descriptive analysis of these genes by Gene Ontology (GO), KEGG pathway and protein domain analyses points to pathways of development and differentiation. We identified a list of genes which are differently methylated in mild and severe OA cartilage. Within the pathways of growth and development new therapeutic targets might arise by improving our understanding of pathogenetic mechanisms in OA.

Noise and Health, 2014

Few studies have been performed to analyze noise levels produced by various surgical instruments ... more Few studies have been performed to analyze noise levels produced by various surgical instruments in the operating room (OR). The highest levels of noise that have been described were due to instruments used for total knee arthroplasty (TKA). These high levels of noise might be a potential health hazard for patients and medical staff. Therefore, we aimed to measure noise levels of current instruments that are widely used worldwide. During a conventional primary TKA the levels of noise in the OR were measured using a Class 1 integrating-averaging sound level meter. The highest A-weighted equivalent level was produced when using a hammer during the implantation of the femoral and tibial components with 90.2 dBA. In total surgical instruments were used for about 10% of the total time of surgery. Noise exposure due to instrument use during TKA does not seem to be a potential health hazard for medical staff or patients.

The Scientific World Journal, 2014

ABSTRACT BACKGROUND: Soft-tissue sarcomas (STS) of the extremities are frequently misdiagnosed at... more ABSTRACT BACKGROUND: Soft-tissue sarcomas (STS) of the extremities are frequently misdiagnosed at initial presentation with a high rate of treatment not in accordance with clinical practice guidelines. The purpose of this study was to detect clinical influence of inadequate surgery prior to referral to a tumour centre. METHODS: Five-year single institution review of patients operated for STS of the extremities in a tertiary referral unit. RESULTS: A total of 116 patients underwent curative surgery for STS between 1998 and 2003. A total of 59 (51%) patients were operated contrary to current clinical guidelines before referral (group B). A total of 54 (92%) of these patients were operated without previous biopsy. Group B had a significantly higher rate of intralesional margins (p < 0.001), a smaller diameter of primary lesion (p = 0.007), a higher rate of additional plastic surgery after re-resection (p = 0.009) and a longer period before referral (p < 0.001) than patients treated according to treatment guidelines (group A). There was no influence on survival, local recurrence or metastasis. CONCLUSIONS: There is a need for the reduction of inadequate surgery for STS. GRUNDLAGEN: Weichteilsarkome (WTSA) sind seltene mesenchymale Tumore des Stütz- und Bewegungsapparates mit einer hohen Inzidenz an primären Fehldiagnosen und Therapie außerhalb bestehender Richtlinien. Im Zuge dieser retrospektiven Kohortenanalyse wurde der Einfluss von primär inadäquater chirurgischer Therapie vor Transferierung an ein Tumorzentrum analysiert. METHODIK: Prospektiv geplante Fünfjahresbeobachtung an einem tertiären Zentrum für Tumore des Stütz- und Bewegungsapparates. ERGEBNISSE: 116 Patienten wurden im Zeitraum zwischen 1998 und 2003 wegen eines WTSA operiert. 59 (51 %) Patienten(d) wurden vor ihrer Transferierung andernorts inadäquat chirurgisch behandelt. 54 (92 %) Patienten von diesen wurden ohne vorangegangene Biopsie operiert und zeigten eine signifikant höhere Rate an intraläsionalen Resektionsgrenzen (p < 0,0001), einen geringeren mittleren Tumordurchmesser (p = 0,007), eine höhere Rate an plastisch chirurgischen Deckungen bei erfolgter Definitivresektion (p = 0,009) und einen längeren mittleren Zeitraum bis zur Zuweisung an ein Zentrum (p < 0,0001) als Patienten, die primär adäquat chirurgisch behandelt wurden. Es war kein Einfluss auf Überleben, Lokalrezidivrate oder Metastasierungsrate erkennbar. SCHLUSSFOLGERUNGEN: Es besteht die Notwendigkeit zur Reduktion inadäquater chirurgischer Therapie von Patienten mit Weichteilsarkomen.

Das Knochenskelett ist nach Lunge und Leber die dritthäufigste Lokalisation von metastatischen Ab... more Das Knochenskelett ist nach Lunge und Leber die dritthäufigste Lokalisation von metastatischen Absiedelungen [30]. Eine besonders hohe Inzidenz für Skelettmetastasen konnte bei Mamma-, Prostata-, Bronchus-, Nieren-und Schildrüsenkarzinom nachgewiesen werden [15]. Pathologische Frakturen wurden vorwiegend bei osteolytischen Adenokarzinommetastasen der Lunge, Mamma, Niere, Schilddrüse und des Gastrointestinaltraktes beobachtet [1, 3]. Nach der Wirbelsäule und dem Becken treten Knochenmetastasen am häufigsten an den Extremitäten auf. Die proximalen gut durchbluteten Enden des Femurs und Humerus sind häufiger als alle anderen langen Röhrenknochen des Extremitätenskeletts von Karzinommetastasen bzw. pathologischen Frakturen betroffen [21, 27].

Zusammenfassung GRUNDLAGEN: Grading, Histopathologie, Größe und Art der chirurgischen Resektion ... more Zusammenfassung GRUNDLAGEN: Grading, Histopathologie, Größe und Art der chirurgischen Resektion sind wichtige prognostische Faktoren im biologischen Verhalten von Liposarkomen. METHODIK: In Hinblick auf Rezidiv, Metastasen und Überleben wurden 80 Patienten mit Liposarkom auf klinische und histologische Charakteristika nachuntersucht. ERGEBNISSE: Die Fünf-Jahres-Rate ohne Ereignis (Metastasen, Rezidiv oder Tod durch die Erkrankung) war 82 %. Stärkster prognostischer Faktor war das Tumorgrading. Patienten mit

Trapezium resection with suspension and interposition arthroplasty of the thumb-carpometacarpal j... more Trapezium resection with suspension and interposition arthroplasty of the thumb-carpometacarpal joint is a common method for treatment of severe osteoarthritis of the 1st carpometacarpal joint. We performed a single center retrospective data analysis after trapezium resection with suspension and interposition arthroplasty of the thumb-carpometacarpal joint with emphasis on quality of life and radiological parameters 3.4 years (1.2-8.7 years) after operation in 60 patients. Pre- and postoperative pain was analysed with VAS, function was measured using the DASH score, pinch grip power with a pinchmeter. Subjective outcome was rated excellent in 42 cases (64.6%), good in 17 (26.2%), fair in 3 (4.6%) and 3 times (4.6%) poor. 56 patients (93.3%) would like to be operated again; 4 patients (6.7%) would deny an operation retrospectively. In the VAS pain was reduced by about 75% compared to the preoperative value. The pinch grip was increased by 46.6% compared to the preoperative value. The rate of major complications was 1.5% and of minor complications 9.2 %. Trapezium resection with suspension and interposition arthroplasty can increase the quality of life and reduce pain in patients with severe osteoarthritis of the 1st carpometacarpal joint. The rate of complications is low. Outcome assessment is possible by subjective parameters. Objective values like the range of movement or the decrease of the distance between metacarpal I and scaphoid do not correlate with outcome.

The main reasons for fine needle aspiration (FNA) failure are insufficient number of cells in the... more The main reasons for fine needle aspiration (FNA) failure are insufficient number of cells in the sample, nonrepresentative samples, and contamination of samples. The aim of this study was to measure the number of cells harvested by a new needle system with an aeration aperture (Thyrosampler) in comparison with a conventional FNA system (C-FNA). Under a double-blind setting, 30 aspirations, 15 with each system (C-FNA, Thyrosampler), were done in randomized order and recorded. The median total number of cells was 59 680 cells/mL with C-FNA and 396 400 cells/mL with Thyrosampler. The needle system with the aeration aperture led to a significantly higher cell amount (564% more cells than the conventional system; P < .005) in needle aspiration biopsy. The new system with the vacuum release feature leads to a significantly higher cell amount in needle aspiration biopsy, which is a well-defined benefit.

... in (a) and (b) or contralateral locations in (c) and (d). In (b) and (d) normal densities wer... more ... in (a) and (b) or contralateral locations in (c) and (d). In (b) and (d) normal densities were plotted above tick marks of observed differences in order to visualize how by means of a cut-point δ a certain proportion of correct pain diagnosis (sensitivity, dark shade) and correct no ...

Anz J Surg, 2009

Interdisciplinary resection of a giant retroperitoneal liposarcoma of 25 kga ns_5160 957..964 Fig... more Interdisciplinary resection of a giant retroperitoneal liposarcoma of 25 kga ns_5160 957..964 Fig. 1. the marginal resection of an fatty intraabdominal mass, 25 kg of weight.

Der Orthopade, May 1, 2009

Das Knochenskelett ist nach Lunge und Leber die dritthäufigste Lokalisation von metastatischen Ab... more Das Knochenskelett ist nach Lunge und Leber die dritthäufigste Lokalisation von metastatischen Absiedelungen [30]. Eine besonders hohe Inzidenz für Skelettmetastasen konnte bei Mamma-, Prostata-, Bronchus-, Nieren-und Schildrüsenkarzinom nachgewiesen werden [15]. Pathologische Frakturen wurden vorwiegend bei osteolytischen Adenokarzinommetastasen der Lunge, Mamma, Niere, Schilddrüse und des Gastrointestinaltraktes beobachtet [1, 3]. Nach der Wirbelsäule und dem Becken treten Knochenmetastasen am häufigsten an den Extremitäten auf. Die proximalen gut durchbluteten Enden des Femurs und Humerus sind häufiger als alle anderen langen Röhrenknochen des Extremitätenskeletts von Karzinommetastasen bzw. pathologischen Frakturen betroffen [21, 27].

European Spine Journal Official Publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cervical Spine Research Society, Sep 12, 2008

Predicting prognosis is the key factor in selecting the proper treatment modality for patients wi... more Predicting prognosis is the key factor in selecting the proper treatment modality for patients with spinal metastases. Therefore, various assessment systems have been designed in order to provide a basis for deciding the course of treatment. Such systems have been proposed by Tokuhashi, Sioutos, Tomita, Van der Linden, and Bauer. The scores differ greatly in the kind of parameters assessed. The aim of this study was to evaluate the prognostic value of each score. Eight parameters were assessed for 69 patients (37 male, 32 female): location, general condition, number of extraspinal bone metastases, number of spinal metastases, visceral metastases, primary tumour, severity of spinal cord palsy, and pathological fracture. Scores according to Tokuhashi (original and revised), Sioutos, Tomita, Van der Linden, and Bauer were assessed as well as a modified Bauer score without scoring for pathologic fracture. Nineteen patients were still alive as of September 2006 with a minimum follow-up of 12 months. All other patients died after a mean period of 17 months after operation. The mean overall survival period was only 3 months for lung cancer, followed by prostate (7 months), kidney (23 months), breast (35 months), and multiple myeloma (51 months). At univariate survival analysis, primary tumour and visceral metastases were significant parameters, while Karnofsky score was only significant in the group including myeloma patients. In multivariate analysis of all seven parameters assessed, primary tumour and visceral metastases were the only significant parameters. Of all seven scoring systems, the original Bauer score and a Bauer score without scoring for pathologic fracture had the best association with survival (P \ 0.001). The data of the present study emphasize that the original Bauer score and a modified Bauer score without scoring for pathologic fracture seem to be practicable and highly predictive preoperative scoring systems for patients with spinal metastases. However, decision for or against surgery should never be based alone on a prognostic score but should take symptoms like pain or neurological compromise into account.

Journal of orthopaedic research : official publication of the Orthopaedic Research Society, Jan 15, 2016

Osteoarthritis (OA) of the hand is a common disease resulting in pain and impaired function. The ... more Osteoarthritis (OA) of the hand is a common disease resulting in pain and impaired function. The pathogenesis of hand OA (HOA) is elusive and models to study it have not been described. Chondrocyte culture has been essential to understand cartilage degeneration, which is a hallmark of OA. We investigated the feasibility of human chondrocyte culture derived from proximal interphalangeal (PIP) finger joints. Hyaline cartilage of the PIP and knee joints was obtained from human cadavers. Chondrocytes harvested up to 236 hours after death of the donors were viable and expressed chondrocyte-specific genes. Gene expression comparing chondrocytes from PIP and knee joints using Affymetrix GeneChip arrays resulted in a unique PIP-specific gene expression pattern. Genes involved in developmental processes including the WNT pathway were differentially expressed between the joints. These findings suggest that our knowledge on chondrocyte biology derived mainly from knee and hip joints may not ap...

Arch Orthop Traum Surg, 2006

Most fractures of the distal radius can be treated by conservative means; however, unstable dista... more Most fractures of the distal radius can be treated by conservative means; however, unstable distal radius fractures (DRFs) require surgical fixation. The purpose of this study was to evaluate functional and radiographic results of DRFs treated with a palmar plating system regarding patient's quality of life. This study reports a total number of 104 DRFs in 102 patients, operatively treated, over a 2-year period with a mean follow up time of 15.6 +/- 7.2 months The patient's average age was 59.9 +/- 18.0 years. The results were evaluated according to the scores of Gartland and Werley, Castaing and the disabilities of the arm, shoulder, and hand (DASH) outcome questionnaire. Ninety-three patients were evaluated at final examination. Excellent and good results were achieved for 92 (98.9%) patients according to score of Gartland and Werley and for 86 (92.5%) patients regarding the scoring system of Castaing. The DASH outcome questionnaire averaged 8.0 +/- 13.7 points. This study shows, in a representative number of cases, that palmar plating of unstable fractures of the distal radius is a safe and effective treatment modality. Early surgical treatment results in optimal outcome regarding patient's quality of life.

European Surgery, Aug 1, 2009

ABSTRACT BACKGROUND: Soft-tissue sarcomas (STS) of the extremities are frequently misdiagnosed at... more ABSTRACT BACKGROUND: Soft-tissue sarcomas (STS) of the extremities are frequently misdiagnosed at initial presentation with a high rate of treatment not in accordance with clinical practice guidelines. The purpose of this study was to detect clinical influence of inadequate surgery prior to referral to a tumour centre. METHODS: Five-year single institution review of patients operated for STS of the extremities in a tertiary referral unit. RESULTS: A total of 116 patients underwent curative surgery for STS between 1998 and 2003. A total of 59 (51%) patients were operated contrary to current clinical guidelines before referral (group B). A total of 54 (92%) of these patients were operated without previous biopsy. Group B had a significantly higher rate of intralesional margins (p < 0.001), a smaller diameter of primary lesion (p = 0.007), a higher rate of additional plastic surgery after re-resection (p = 0.009) and a longer period before referral (p < 0.001) than patients treated according to treatment guidelines (group A). There was no influence on survival, local recurrence or metastasis. CONCLUSIONS: There is a need for the reduction of inadequate surgery for STS. GRUNDLAGEN: Weichteilsarkome (WTSA) sind seltene mesenchymale Tumore des Stütz- und Bewegungsapparates mit einer hohen Inzidenz an primären Fehldiagnosen und Therapie außerhalb bestehender Richtlinien. Im Zuge dieser retrospektiven Kohortenanalyse wurde der Einfluss von primär inadäquater chirurgischer Therapie vor Transferierung an ein Tumorzentrum analysiert. METHODIK: Prospektiv geplante Fünfjahresbeobachtung an einem tertiären Zentrum für Tumore des Stütz- und Bewegungsapparates. ERGEBNISSE: 116 Patienten wurden im Zeitraum zwischen 1998 und 2003 wegen eines WTSA operiert. 59 (51 %) Patienten(d) wurden vor ihrer Transferierung andernorts inadäquat chirurgisch behandelt. 54 (92 %) Patienten von diesen wurden ohne vorangegangene Biopsie operiert und zeigten eine signifikant höhere Rate an intraläsionalen Resektionsgrenzen (p < 0,0001), einen geringeren mittleren Tumordurchmesser (p = 0,007), eine höhere Rate an plastisch chirurgischen Deckungen bei erfolgter Definitivresektion (p = 0,009) und einen längeren mittleren Zeitraum bis zur Zuweisung an ein Zentrum (p < 0,0001) als Patienten, die primär adäquat chirurgisch behandelt wurden. Es war kein Einfluss auf Überleben, Lokalrezidivrate oder Metastasierungsrate erkennbar. SCHLUSSFOLGERUNGEN: Es besteht die Notwendigkeit zur Reduktion inadäquater chirurgischer Therapie von Patienten mit Weichteilsarkomen.

Transactions of the New York Academy of Sciences, Jun 1, 1968

Canadian journal of surgery. Journal canadien de chirurgie

Journal of orthopaedic research : official publication of the Orthopaedic Research Society, Jan 21, 2015

Formation of chondrocyte clusters is not only a morphological sign of osteoarthritis but it is al... more Formation of chondrocyte clusters is not only a morphological sign of osteoarthritis but it is also observed in cell culture. Active locomotion of chondrocytes is controlled by integrins in vitro. Integrins bind to Laminin-A4 (LAMA4), a protein that is highly expressed in vivo in clusters of hypertrophic chondrocytes. We tested if LAMA4 is relevant for cluster formation. Human chondrocytes were cultured in a 2D matrigel model and treated with different concentrations of a monoclonal inhibitory anti-LAMA4-antibody. Migration and cluster formation was analysed using live cell imaging technique. Full genome gene expression analysis was performed to assess the effect of LAMA4 inhibition. The data set were screened for genes relevant to cell motility. F-actin staining was performed to document cytoskeletal changes. Anti-LAMA4 treatment significantly reduced the rate of cluster formation in human chondrocytes. Cells changed their surface morphology and exhibited fewer protrusions. Express...

Canadian journal of surgery. Journal canadien de chirurgie, 2008

Journal of Orthopaedic Research, 2014

The development of osteoarthritis (OA) depends on genetic and environmental factors, which influe... more The development of osteoarthritis (OA) depends on genetic and environmental factors, which influence the biology of the chondrocyte via epigenetic regulation. Changes within the epigenome might lead the way to discovery of new pathogenetic pathways. We performed a genome-wide methylation screening to identify potential differences between paired mild and severe osteoarthritic human cartilage. Sixteen female patients suffering from OA underwent total knee joint replacement. Cartilage specimens collected from corresponding macroscopically undamaged and from damaged areas were processed for DNA extraction and histology to evaluate the histological grading of the disease. Paired specimens were analysed for the methylation status of the whole genome using human promoter microarrays (Agilent, Santa Clara, CA). Selected target genes were then validated via methylation-specific qPCR. One thousand two hundred and fourteen genetic targets were identified differentially methylated between mild and severe OA. One thousand and seventy of these targets were found hypermethylated and 144 hypomethylated. The descriptive analysis of these genes by Gene Ontology (GO), KEGG pathway and protein domain analyses points to pathways of development and differentiation. We identified a list of genes which are differently methylated in mild and severe OA cartilage. Within the pathways of growth and development new therapeutic targets might arise by improving our understanding of pathogenetic mechanisms in OA.

Noise and Health, 2014

Few studies have been performed to analyze noise levels produced by various surgical instruments ... more Few studies have been performed to analyze noise levels produced by various surgical instruments in the operating room (OR). The highest levels of noise that have been described were due to instruments used for total knee arthroplasty (TKA). These high levels of noise might be a potential health hazard for patients and medical staff. Therefore, we aimed to measure noise levels of current instruments that are widely used worldwide. During a conventional primary TKA the levels of noise in the OR were measured using a Class 1 integrating-averaging sound level meter. The highest A-weighted equivalent level was produced when using a hammer during the implantation of the femoral and tibial components with 90.2 dBA. In total surgical instruments were used for about 10% of the total time of surgery. Noise exposure due to instrument use during TKA does not seem to be a potential health hazard for medical staff or patients.

The Scientific World Journal, 2014

ABSTRACT BACKGROUND: Soft-tissue sarcomas (STS) of the extremities are frequently misdiagnosed at... more ABSTRACT BACKGROUND: Soft-tissue sarcomas (STS) of the extremities are frequently misdiagnosed at initial presentation with a high rate of treatment not in accordance with clinical practice guidelines. The purpose of this study was to detect clinical influence of inadequate surgery prior to referral to a tumour centre. METHODS: Five-year single institution review of patients operated for STS of the extremities in a tertiary referral unit. RESULTS: A total of 116 patients underwent curative surgery for STS between 1998 and 2003. A total of 59 (51%) patients were operated contrary to current clinical guidelines before referral (group B). A total of 54 (92%) of these patients were operated without previous biopsy. Group B had a significantly higher rate of intralesional margins (p < 0.001), a smaller diameter of primary lesion (p = 0.007), a higher rate of additional plastic surgery after re-resection (p = 0.009) and a longer period before referral (p < 0.001) than patients treated according to treatment guidelines (group A). There was no influence on survival, local recurrence or metastasis. CONCLUSIONS: There is a need for the reduction of inadequate surgery for STS. GRUNDLAGEN: Weichteilsarkome (WTSA) sind seltene mesenchymale Tumore des Stütz- und Bewegungsapparates mit einer hohen Inzidenz an primären Fehldiagnosen und Therapie außerhalb bestehender Richtlinien. Im Zuge dieser retrospektiven Kohortenanalyse wurde der Einfluss von primär inadäquater chirurgischer Therapie vor Transferierung an ein Tumorzentrum analysiert. METHODIK: Prospektiv geplante Fünfjahresbeobachtung an einem tertiären Zentrum für Tumore des Stütz- und Bewegungsapparates. ERGEBNISSE: 116 Patienten wurden im Zeitraum zwischen 1998 und 2003 wegen eines WTSA operiert. 59 (51 %) Patienten(d) wurden vor ihrer Transferierung andernorts inadäquat chirurgisch behandelt. 54 (92 %) Patienten von diesen wurden ohne vorangegangene Biopsie operiert und zeigten eine signifikant höhere Rate an intraläsionalen Resektionsgrenzen (p < 0,0001), einen geringeren mittleren Tumordurchmesser (p = 0,007), eine höhere Rate an plastisch chirurgischen Deckungen bei erfolgter Definitivresektion (p = 0,009) und einen längeren mittleren Zeitraum bis zur Zuweisung an ein Zentrum (p < 0,0001) als Patienten, die primär adäquat chirurgisch behandelt wurden. Es war kein Einfluss auf Überleben, Lokalrezidivrate oder Metastasierungsrate erkennbar. SCHLUSSFOLGERUNGEN: Es besteht die Notwendigkeit zur Reduktion inadäquater chirurgischer Therapie von Patienten mit Weichteilsarkomen.

Das Knochenskelett ist nach Lunge und Leber die dritthäufigste Lokalisation von metastatischen Ab... more Das Knochenskelett ist nach Lunge und Leber die dritthäufigste Lokalisation von metastatischen Absiedelungen [30]. Eine besonders hohe Inzidenz für Skelettmetastasen konnte bei Mamma-, Prostata-, Bronchus-, Nieren-und Schildrüsenkarzinom nachgewiesen werden [15]. Pathologische Frakturen wurden vorwiegend bei osteolytischen Adenokarzinommetastasen der Lunge, Mamma, Niere, Schilddrüse und des Gastrointestinaltraktes beobachtet [1, 3]. Nach der Wirbelsäule und dem Becken treten Knochenmetastasen am häufigsten an den Extremitäten auf. Die proximalen gut durchbluteten Enden des Femurs und Humerus sind häufiger als alle anderen langen Röhrenknochen des Extremitätenskeletts von Karzinommetastasen bzw. pathologischen Frakturen betroffen [21, 27].

Zusammenfassung GRUNDLAGEN: Grading, Histopathologie, Größe und Art der chirurgischen Resektion ... more Zusammenfassung GRUNDLAGEN: Grading, Histopathologie, Größe und Art der chirurgischen Resektion sind wichtige prognostische Faktoren im biologischen Verhalten von Liposarkomen. METHODIK: In Hinblick auf Rezidiv, Metastasen und Überleben wurden 80 Patienten mit Liposarkom auf klinische und histologische Charakteristika nachuntersucht. ERGEBNISSE: Die Fünf-Jahres-Rate ohne Ereignis (Metastasen, Rezidiv oder Tod durch die Erkrankung) war 82 %. Stärkster prognostischer Faktor war das Tumorgrading. Patienten mit

Trapezium resection with suspension and interposition arthroplasty of the thumb-carpometacarpal j... more Trapezium resection with suspension and interposition arthroplasty of the thumb-carpometacarpal joint is a common method for treatment of severe osteoarthritis of the 1st carpometacarpal joint. We performed a single center retrospective data analysis after trapezium resection with suspension and interposition arthroplasty of the thumb-carpometacarpal joint with emphasis on quality of life and radiological parameters 3.4 years (1.2-8.7 years) after operation in 60 patients. Pre- and postoperative pain was analysed with VAS, function was measured using the DASH score, pinch grip power with a pinchmeter. Subjective outcome was rated excellent in 42 cases (64.6%), good in 17 (26.2%), fair in 3 (4.6%) and 3 times (4.6%) poor. 56 patients (93.3%) would like to be operated again; 4 patients (6.7%) would deny an operation retrospectively. In the VAS pain was reduced by about 75% compared to the preoperative value. The pinch grip was increased by 46.6% compared to the preoperative value. The rate of major complications was 1.5% and of minor complications 9.2 %. Trapezium resection with suspension and interposition arthroplasty can increase the quality of life and reduce pain in patients with severe osteoarthritis of the 1st carpometacarpal joint. The rate of complications is low. Outcome assessment is possible by subjective parameters. Objective values like the range of movement or the decrease of the distance between metacarpal I and scaphoid do not correlate with outcome.

The main reasons for fine needle aspiration (FNA) failure are insufficient number of cells in the... more The main reasons for fine needle aspiration (FNA) failure are insufficient number of cells in the sample, nonrepresentative samples, and contamination of samples. The aim of this study was to measure the number of cells harvested by a new needle system with an aeration aperture (Thyrosampler) in comparison with a conventional FNA system (C-FNA). Under a double-blind setting, 30 aspirations, 15 with each system (C-FNA, Thyrosampler), were done in randomized order and recorded. The median total number of cells was 59 680 cells/mL with C-FNA and 396 400 cells/mL with Thyrosampler. The needle system with the aeration aperture led to a significantly higher cell amount (564% more cells than the conventional system; P < .005) in needle aspiration biopsy. The new system with the vacuum release feature leads to a significantly higher cell amount in needle aspiration biopsy, which is a well-defined benefit.

... in (a) and (b) or contralateral locations in (c) and (d). In (b) and (d) normal densities wer... more ... in (a) and (b) or contralateral locations in (c) and (d). In (b) and (d) normal densities were plotted above tick marks of observed differences in order to visualize how by means of a cut-point δ a certain proportion of correct pain diagnosis (sensitivity, dark shade) and correct no ...