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Frauenfeld, Switzerland

Zettl R.,Kantonsspital Frauenfeld | Eschbach D.,Justus Liebig University | Ruchholtz S.,Justus Liebig University
International Orthopaedics | Year: 2015

Purpose: Periprosthetic acetabular fractures are rare and in the current literature largely underreported. The management is reported to be difficult. Treatment varies from non-operative to open reduction and internal fixation up to revision of the acetabular components. Methods: A prospective consecutive case series in acetabular fractures was performed in a level 1 trauma centre. All patients with pre-existing total hip replacement were followed up for one year. Perioperative data, complications, radiological results, functional outcome and quality of life were measured. Results: Eight (15 %) of 53 patients who were included in the study underwent total hip arthroplasty before and had stable implants at time of fracture. Mean age of the patients was 83 years. All of them were female. Mean operative time was 85 minutes. There were no soft tissue complications like infection or nerve damage in the post-operative course. No revision was needed. Two patients died in between the follow up. The Harris hip score was a mean of 77, with quality of life comparable to persons in the same age. Conclusions: Minimally invasive reconstruction of the anterior column is a viable method to conserve stable acetabular components in this type of fracture. Short operation time and limited incisions are the most conclusive advantages. © 2015, SICOT aisbl.

Kohler S.,University of Zurich | Tschopp O.,University of Zurich | Sze L.,University of Zurich | Neidert M.,University of Zurich | And 4 more authors.
General and Comparative Endocrinology | Year: 2013

Background: Acromegaly is an illness usually defined by excessively high growth hormone (GH) and insulin like growth factor 1 (IGF-1) levels, the latter mainly reflecting GH action on the liver. IGF-1, also known as somatomedin C, mediates several actions of GH. The diagnosis and management of acromegaly is relatively straight forward, but long-term follow-up of patients can be difficult, as elevated IGF-1 levels can occur in the presence of apparently normalised GH levels and late recurrence of acromegaly may arise despite previous suppression on oral glucose tolerance testing. Data suggest this applies especially to patients in whom the GH receptor lacks exon 3. In such patients, GH may not always be a useful marker of disease, and traditional GH cut-offs may be misleading. Recent data suggest that soluble Klotho (sKlotho), besides and in addition to IGF-1, may help monitor the activity of GH-producing adenomas (presumably reflecting GH action on the kidneys) and may be a useful supplementary tool. Methods: GHR genotyping was performed in 112 patients with acromegaly. IGF-1 and sKlotho levels were measured in the sera of patients before and after transsphenoidal surgery, with emphasis on patients judged inconclusively cured by surgery or with small residual tumour masses shortly after surgery. Patients were assessed for recurrence of acromegaly with GH levels (random or nadir during an oGTT). Results: Of the 48 patients who underwent surgery between 2000 and 2009 and who had well-documented longer term follow-up at our institution, 29 had no biochemical evidence of residual disease activity after transsphenoidal surgery (marked reduction in IGF-1 and sKlotho levels, GH suppressible to <1. ng/ml) and were classified as in remission. 2 of these patients developed recurrent symptoms of acromegaly during follow-up with increasing levels of IGF-1 and sKlotho, and both patients were carriers of the d3-GHR genotype. Conclusions: Acromegalic patients with the d3-GHR polymorphism might be - for a given low postsurgical GH level - at higher risk for recurrence and may require a lower GH nadir during oGTT to be classified as in remission. Soluble Klotho could be useful in the follow-up of acromegalic patients. The question arises whether sKlotho not only reflects the activity of GH-secreting pituitary adenomas but whether Klotho (ectodomain clipping?) could also mediate selected actions of GH. © 2013 The Authors.

El-Zayat B.F.,University of Marburg | Efe T.,University of Marburg | Ruchholtz S.,University of Marburg | Khatib S.,University of Marburg | And 3 more authors.
BMC Musculoskeletal Disorders | Year: 2014

Background: The aim of this cadaveric study was to compare a polyaxial (NCB®, Zimmer) to a fixed-angle monoaxial locking plate (PERILOC®, Smith & Nephew) in comminuted fractures of the distal femur regarding stability of the construct. Up to date there is no published biomechanical data concerning polyaxial plating in cadaveric distal femurs. Methods: Fourteen formalin fixed femora were scanned by dual-energy x-ray absorptiometry. As fracture model an unstable supracondylar comminuted fracture was simulated. Fractures were pairwise randomly fixed either with a mono- (group A) or a polyaxial (group B) distal femur plate. The samples were tested in a servohydraulic mechanical testing system starting with an axial loading of 200 N following an increase of 200 N in every step with 500 cycles in every sequence up to a maximum of 2 000 N. The end points were implant failure or relevant loss of reduction. Data records included for each specimen time, number of cycles, axial load and axial displacement. Statistical analysis was performed using the exact Wilcoxon signed rank test. Results: The mean donor age at the time of death was 75 years. The bone mass density (BMD) of the femurs in both groups was comparable and showed no statistically significant differences. Five bones failed before reaching the maximum applied force of 2000 N. Distribution curves of all samples in both groups, showing the plastic deformation in relation to the axial force, showed no statistically significant differences. Conclusions: Operative stabilization of distal femur fractures can be successfully and equally well achieved using either a monoaxial or a polyaxial locking plate. Polyaxial screw fixation may have advantages if intramedullary implants are present.

Sze L.,University of Zurich | Bernays R.L.,University of Zurich | Zwimpfer C.,University of Zurich | Wiesli P.,Kantonsspital Frauenfeld | And 2 more authors.
Journal of Internal Medicine | Year: 2012

Objectives. Klotho-deficient mice develop a syndrome resembling accelerated ageing, and genetic variants of Klotho have been associated with human ageing. In humans, serum levels of soluble Klotho decrease with age and with chronic renal failure. The aim of our study was to examine the relationship between excess growth hormone (GH) and serum levels of Klotho in patients with acromegaly, a disease usually caused by a pituitary adenoma, which is associated with high phosphate levels and reduced life expectancy. Patients and design. We determined the levels of soluble Klotho, GH and insulin-like growth factor 1 (IGF-1) in serum samples from 24 consecutive patients with acromegaly (nine women/15 men, age 28-76years) before and after transsphenoidal surgery. Results. Soluble Klotho levels were excessively high at baseline (mean±SEM, 4.2±0.7ngmL -1) and correlated with GH (r=0.64), IGF-1 (r=0.57) and tumour size (r=0.5). In multiple regression analysis, soluble Klotho was associated with GH after correction for age, gender and levels of creatinine and phosphate (P=0.029). After surgery, GH and IGF-1 levels decreased in all patients (from 26.3±5.2 to 2.6±0.6μgL -1, P <0.0001, and from 588±35 to 193±12μgL -1, P<0.001, 0.0001, respectively). Creatinine increased from 71±3 to 80±3μmolL -1 (P<0.001), and phosphate decreased from 1.37±0.04 to 1.06± 0.02mmolL -1 (P<0.001). The markedly increased preoperative levels of soluble Klotho returned towards normal after surgery (0.7±0.1ngmL -1, P<0.0001). Conclusions. This is the first study to show dramatically increased soluble Klotho levels in an acquired disease in humans. Reversal following tumour removal suggests a causal relation between the GH-producing adenoma and high serum Klotho concentration in acromegaly. © 2012 The Association for the Publication of the Journal of Internal Medicine.

Winterhalder R.,Kantonsspital Luzern | Hoesli P.,Etablissements Hospitaliers Nord Vaudois | Delmore G.,Kantonsspital Frauenfeld | Pederiva S.,Kantonsspital Baden | And 3 more authors.
Oncology | Year: 2011

Objectives: While oral anticancer treatment has increased the convenience for patients with no risk of venous access complications compared to intravenous drug administration, a high level of compliance cannot always be assumed. The aim of the present report was to evaluate real-life drug adherence in a prospective cohort analysis of patients with gastrointestinal or breast cancer treated with capecitabine-based chemotherapy. Methods: Twenty-nine Swiss oncologists recruited patients receiving capecitabine, either as monotherapy or in combination with other chemotherapeutic agents, in a prospective fashion. Patients recorded both their capecitabine intake and any adverse effects each day in patient diaries. Results: A total of 177 patients were included, 143 (81%) with gastrointestinal tumours and 34 (19%) with breast cancer. Overall, 161 patients (91%) were considered as fully compliant, while 16 patients (9%) reported some kind of compliance error. Reasons for non-compliance included forgetting to take treatment (n = 9), side effects (n = 4) and misunderstanding instructions (n = 3). Self-reported compliance was not influenced by age or Eastern Cooperative Oncology Group performance status, but there was a trend towards better compliance with capecitabine therapy if fewer adverse effects occurred (p = 0.07, simple logistic regression). Conclusions: Self-reported compliance with capecitabine-based therapy in clinical practice is high and seems to be adversely affected by side effects. © 2011 S. Karger AG, Basel.

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