St Vincent Hospital Vienna

Vienna, Austria

St Vincent Hospital Vienna

Vienna, Austria
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Pauzenberger L.,St. Vincent Shoulder and Sports Clinic | Domej M.A.,St. Vincent Shoulder and Sports Clinic | Heuberer P.R.,St. Vincent Shoulder and Sports Clinic | Hexel M.,St. Vincent Shoulder and Sports Clinic | And 4 more authors.
Bone and Joint Journal | Year: 2017

The purpose of the present study was to evaluate the impact of intravenous tranexamic acid on the reduction of blood loss, transfusion rate, and early post-operative clinical outcome in total shoulder arthroplasty. Patients and Methods A randomised, placebo-controlled trial which included 54 patients undergoing unilateral primary stemless anatomical or stemmed reverse total shoulder arthroplasty was undertaken. Patients received either 100 ml saline (placebo, n = 27), or 100 ml saline together with 1000 mg of tranexamic acid (TXA, n = 27) intravenously prior to skin incision and during wound closure. Peri-operative blood loss via an intra-articular drain was recorded and total blood loss was calculated. The post-operative transfusion rate was documented. Assessment of early clinical parameters included the visual analogue scale for pain (VAS), documentation of haematoma formation and adverse events. Results Mean peri-operative blood drainage (placebo: 170 ml versus TXA: 50 ml, p = 0.001) and calculated mean total blood loss (placebo: 1248.2 ml versus TXA: 871.0 ml, p = 0.009) were significantly lower in the TXA group. No transfusions were necessary during the study period in either group. Mean VAS for pain significantly decreased from pre-operative (VAS 7) to the early post-operative period (VAS 1.7, p < 0.001). Significant differences regarding mean post-operative pain between placebo (VAS 2.0) and TXA (VAS 1.3) were detected (p = 0.05). The occurrence of haematomas was significantly more frequent in the placebo (59.3%, n = 16) than in the TXA group (25.9%, n = 6, p = 0.027). Whereas only mild haematomas developed in the TXA group, in the placebo group a total of 22.2% (n = 6) developed either moderate or severe haematomas. No adverse events associated with administration of TXA occurred. Conclusion Intravenous administration of TXA successfully reduced mean peri-operative blood drainage, total estimated blood loss, pain during the first post-operative days, and haematoma formation in total shoulder arthroplasty. © 2017 The British Editorial Society of Bone & Joint Surgery.

Patsch J.M.,Medical University of Vienna | Kiefer F.W.,Medical University of Vienna | Varga P.,Vienna University of Technology | Pail P.,Medical University of Vienna | And 8 more authors.
Metabolism: Clinical and Experimental | Year: 2011

Although obesity traditionally has been considered a condition of low risk for osteoporosis, this classic view has recently been questioned. The aim of this study was to assess bone microarchitecture and turnover in a mouse model of high-fat diet-induced obesity. Seven-week-old male C57BL/6J mice (n = 18) were randomized into 3 diet groups. One third (n = 6) received a low-fat diet for 24 weeks, one third was kept on an extended high-fat diet (eHF), and the remaining was switched from low-fat to high-fat chow 3 weeks before sacrifice (sHF). Serum levels of insulin, leptin, adiponectin, osteocalcin, and cross-linked telopeptides of type I collagen (CTX) were measured. In addition, bone microarchitecture was analyzed by micro-computed tomography; and lumbar spine bone density was assessed by dual-energy x-ray absorptiometry. The CTX, body weight, insulin, and leptin were significantly elevated in obese animals (sHF: +48%, +24%, +265%, and +102%; eHF: +43%, +52%, +761%, and +292%). The CTX, body weight, insulin, and leptin showed a negative correlation with bone density and bone volume. Interestingly, short-term high-fat chow caused similar bone loss as extended high-fat feeding. Bone volume was decreased by 12% in sHF and 19% in eHF. Bone mineral density was 25% (sHF) and 27% (eHF) lower when compared with control mice on low-fat diet. As assessed by the structure model index, bone microarchitecture changed from plate- to rod-like appearance upon high-fat challenge. Trabecular and cortical thickness remained unaffected. Short-term and extended high-fat diet-induced obesity caused significant bone loss in male C57BL/6J mice mainly because of resorptive changes in trabecular architecture. © 2011 Elsevier Inc. All rights reserved.

Gartner W.,Medical University of Vienna | Gartner W.,St Vincent Hospital Vienna | Ilhan A.,Medical University of Vienna | Neziri D.,Medical University of Vienna | And 7 more authors.
Neuro-Oncology | Year: 2010

We detected distinct plasma concentration profiles of S100B, neuropeptide Y, and secretagogin in 3 of 191 patients enrolled in a previous study investigating brain-tissue-related markers in the blood of patients with atrial fibrillation. Intriguingly, 2 of these 3 patients, both of whom were without neurological symptoms at the time of blood sampling, were diagnosed with malignant glioma (MG) approximately 1 year later. To our knowledge, this is the first report indicating that distinct blood biomarker profiles may be detected long before clinical manifestation of MG. © The Author(s) 2010.

Valentinitsch A.,Medical University of Vienna | Valentinitsch A.,University of California at San Francisco | Patsch J.M.,Medical University of Vienna | Patsch J.M.,University of California at San Francisco | And 8 more authors.
Bone | Year: 2013

High resolution peripheral quantitative computed tomography (HR-pQCT) permits the non-invasive assessment of cortical and trabecular bone density, geometry, and microarchitecture. Although researchers have developed various post-processing algorithms to quantify HR-pQCT image properties, few of these techniques capture image features beyond global structure-based metrics. While 3D-texture analysis is a key approach in computer vision, it has been utilized only infrequently in HR-pQCT research. Motivated by high isotropic spatial resolution and the information density provided by HR-pQCT scans, we have developed and evaluated a post-processing algorithm that quantifies microarchitecture characteristics via texture features in HR-pQCT scans. During a training phase in which clustering was applied to texture features extracted from each voxel of trabecular bone, three distinct clusters, or trabecular microarchitecture classes (TMACs) were identified. These TMACs represent trabecular bone regions with common texture characteristics. The TMACs were then used to automatically segment the voxels of new data into three regions corresponding to the trained cluster features. Regional trabecular bone texture was described by the histogram of relative trabecular bone volume covered by each cluster. We evaluated the intra-scanner and inter-scanner reproducibility by assessing the precision errors (PE), intra class correlation coefficients (ICC) and Dice coefficients (DC) of the method on 14 ultradistal radius samples scanned on two HR-pQCT systems. DC showed good reproducibility in intra-scanner set-up with a mean of 0.870. ±. 0.027 (no unit). Even in the inter-scanner set-up the ICC showed high reproducibility, ranging from 0.814 to 0.964. In a preliminary clinical test application, the TMAC histograms appear to be a good indicator, when differentiating between postmenopausal women with (n. =. 18) and without (n. =. 18) prevalent fragility fractures. In conclusion, we could demonstrate that 3D-texture analysis and feature clustering seems to be a promising new HR-pQCT post-processing tool with good reproducibility, even between two different scanners. © 2013 Elsevier Inc.

Valentinitsch A.,Medical University of Vienna | Patsch J.M.,Medical University of Vienna | Patsch J.M.,University of California at San Francisco | Deutschmann J.,Medical University of Vienna | And 5 more authors.
Bone | Year: 2012

The quantitative assessment of metabolic bone diseases relies on tissue properties such as bone mineral density (BMD) and bone microarchitecture. In spite of an increasing number of publications using high-resolution peripheral quantitative computed-tomography (HR-pQCT), the accurate and reproducible separation of cortical and trabecular bone remains challenging. In this paper, we present a novel, fully automated, threshold-independent technique for the segmentation of cortical and trabecular bone in HR-pQCT scans. This novel post-processing method is based on modeling appearance characteristics from manually annotated cases. In our experiments the algorithm automatically selected texture features with high differentiating power and trained a classifier to separate cortical and trabecular bone. From this mask, cortical thickness and tissue volume could be calculated with high accuracy. The overlap between the proposed threshold-independent segmentation tool (TIST) and manual contouring was 0.904 ± 0.045 (Dice coefficient). In our experiments, TIST obtained higher overall accuracy in our measurements than other techniques. © 2012.

Heuberer P.,St Vincent Hospital Vienna | Kranzl A.,Orthopaedic Hospital Speising | Laky B.,St Vincent Hospital Vienna | Anderl W.,St Vincent Hospital Vienna | Wurnig C.,Orthopaedic Hospital Speising
Archives of Orthopaedic and Trauma Surgery | Year: 2015

Introduction: Restoring optimal strength and biomechanics of a pathologic shoulder knowledge of activity patterns of healthy glenohumeral muscles is mandatory. Yet, data on normal shoulder muscle activity are not always conclusive. The study was undertaken (a) to evaluate muscle activity patterns in the healthy shoulder using surface and fine-wire electromyography (EMG), and (b) to assess method’s suitability in the clinical setting especially regarding painfulness and practicability.Materials and methods: Surface and fine-wire EMG was performed on 11 healthy subjects (2f/9m, Ø age 28 years) to assess 14 muscles including rotator cuff muscles during 8 planar standardised shoulder movements (abduction, forward flexion, internal and external rotation in neutral, 45° and 90° abduction). Pain was assessed using the visual analogue scale before testing, after inserting the fine-wire electrodes, after maximal voluntary contraction, before and after exercises, and after electrode removal.Results: The most important finding regarding EMG activity patterns in the healthy shoulder was that the subscapularis activity was found to play a major role in abduction and forward flexion. Furthermore, this study was able to show that EMG measurements, especially fine-wire EMG, is prone to high failure rates (up to 32 %); however, pain was not a limiting factor.Conclusion: The present study (1) revealed a new insight, especially finding the subscapularis activity playing a major role in abduction and forward flexion of the healthy shoulder; and (2) motion analysis system and the use of fine-wire electrodes were prone to failure; however, pain was not a limiting factor.Level of evidence: Basic Science, Electrodiagnostic Study. © 2015, Springer-Verlag Berlin Heidelberg.

Patsch J.M.,Center for Pathophysiology | Patsch J.M.,Medical University of Vienna | Kohler T.,B cube AG | Berzlanovich A.,Medical University of Vienna | And 5 more authors.
Journal of Bone and Mineral Research | Year: 2011

Male idiopathic osteoporosis (MIO) is a metabolic bone disease that is characterized by low bone mass, microstructural alterations, and increased fracture risk in otherwise healthy men. Although the detailed pathophysiology of MIO has yet to be clarified, evidence increasingly suggests an osteoblastic defect as the underlying cause. In this study we tested the hypothesis that the expression profile of certain osteoblastic or osteoblast-related genes (ie, WNT10B, RUNX2, Osterix, Osteocalcin, SOST, RANKL, and OPG) is different in iliac crest biopsies of MIO patients when compared with healthy controls. Furthermore, we investigated the relation of local gene expression characteristics with histomorphometric, microstructural, and clinical features. Following written informed consent and diligent clinical patient characterization, iliac crest biopsies were performed in nine men. While RNA extraction, reverse-transcription, and real-time polymerase chain reactions (PCRs) were performed on one biopsy, a second biopsy of each patient was submitted for histomorphometry and micro-computed tomography (μCT). Age-matched bone samples from forensic autopsies served as controls. MIO patients displayed significantly reduced WNT10B, RUNX2, RANKL, and SOST expression. Performing μCT for the first time in MIO biopsies, we found significant decreases in trabecular number and connectivity density. Trabecular separation was increased significantly, but trabecular thickness was similar in both groups. Histomorphometry revealed decreased BV/TV and osteoid volume and fewer osteoclasts in MIO. By providing evidence for reduced local WNT10B, RUNX2, and RANKL gene expression and histomorphometric low turnover, our data support the osteoblast dysfunction model discussed for MIO. Further, MIO seems to lead to a different microstructural pathology than age-related bone loss. Copyright © 2011 American Society for Bone and Mineral Research.

Anderl W.,St Vincent Hospital Vienna | Pauzenberger L.,St Vincent Hospital Vienna | Laky B.,St Vincent Hospital Vienna | Kriegleder B.,St Vincent Hospital Vienna | Heuberer P.R.,St Vincent Hospital Vienna
American Journal of Sports Medicine | Year: 2015

Background: Posttraumatic anteroinferior shoulder dislocations with concomitant glenoid bone loss show high recurrence rates. The open J-bone graft technique for implant-less anatomic restoration of bony glenoid structure has previously been described, whereas results of arthroscopic techniques are currently not available. Purpose: To evaluate clinical and radiological outcome after arthroscopic anatomic reconstruction of the glenoid for recurrent anteroinferior glenohumeral instability. Study Design: Case series; Level of evidence, 4. Methods: Fifteen shoulders of 14 patients with recurrent anteroinferior shoulder instability were prospectively followed after glenoid reconstruction with a modified arthroscopic, implant-free J-bone graft. Preoperatively, the instability severity index score was documented. Patients were followed for a minimum of 2 years using the Rowe score and the Constant score. Subjective outcome was assessed using a visual analog scale (VAS) for pain and the subjective shoulder value for sports (SSVS); satisfaction with procedure outcome was also rated. Range of motion was recorded. Incidence of recurrent instability, defined as dislocation, subluxation, or persistent apprehensiveness, was documented. Pre- and postoperative (1 day and 3, 12, and 24 months) computed tomographic images were used to evaluate glenoid bone loss, reconstruction of the glenoid, and graft remodeling. Results: All preoperative scores (Rowe score: 57.6 ± 14.4; Constant score: 70.9 ± 8.9; VAS: 4.4 ± 2.6; SSVS: 31.4% ± 19.5%) were significantly (P ≤.02) improved at final follow-up (Rowe score: 98.6 ± 1.5; Constant score: 96.3 ± 3.9; VAS: 0.2 ± 0.6; SSVS: 95.6% ± 3.8%). The preoperative glenoid area (82.1% ± 4.5%) was significantly increased immediately after surgery to 99.2% ± 6.6% (P <.001). After a physiological remodeling process, the glenoid area remained significantly increased at the latest follow-up (89.5 ± 3.2%, P <.001). J-bone grafting successfully restored glenoid concavity by significantly increasing concavity extent and depth from preoperative (19.8 ± 2.1 and 0.9 ± 0.6 mm, respectively) to postoperative (24.0 ± 2.1 and 2.1 ± 0.8 mm, respectively) (P <.001). There were no recurrent instabilities. One traumatic graft fracture occurred during the follow-up period. Conclusion: The arthroscopic J-bone graft technique permits minimally invasive reconstruction of anteroinferior glenoid defects and provided excellent early clinical outcome without recurrent instability in posttraumatic shoulder dislocations. A physiological remodeling process leads to restoration of a more natural glenoid anatomy. © 2016 American Orthopaedic Society for Sports Medicine.

Muschitz C.,Medical University of Vienna | Kocijan R.,Medical University of Vienna | Fahrleitner-Pammer A.,Medical University of Graz | Pavo I.,University of Szeged | And 4 more authors.
Journal of Bone and Mineral Research | Year: 2014

Nine month teriparatide (TPTD) monotherapy followed by co-administration of raloxifene (RAL) or alendronate (ALN) for another nine 9 months resulted in incremental bone mineral density (BMD) increase. The aim of this study was to investigate the effects of continued antiresorptive treatments for 12 months in the extension phase. Postmenopausal women (n=125) with severe osteoporosis on ongoing TPTD treatment for 9 months were randomized into three open-label groups for another 9 months: ALN (70 mg/week, n=41), RAL (60mg/d, n=37) in addition to TPTD or no additional medication (n=47) except Ca and vitamin D. After discontinuation of TPTD the respective antiresorptives were continued for a further 12 months, while patients in the TPTD monotherapy group received Ca and vitamin D. Amino-terminal propeptide of type I procollagen (P1NP) and cross-linked C-telopeptide (CTX), areal and volumetric BMD at the lumbar spine (LS) and hip were assessed. ALN resulted in continued BMD increase in LS (4.3±1.5%; mean±SD), femoral neck (4.2±1.6%) and total hip (4±1.6%; p<0.001 for all), while RAL was only effective at the LS (2.4±1.7%, p<0.001) but no changes at the femoral neck (0.4±1.4%) or total hip (-0.8±1.5%) were observed. Cortical bone only increased in the ALN group (femoral neck 6.7±2.7% and -1.3±2.5%; total hip 13.8±2.9% and -2.3±2.5% for ALN and RAL, p<0.001 for all; respectively). Analyzing the entire 30 months of therapy, the ALN group revealed the largest BMD increase in all regions. Our results suggest that the addition of ALN to ongoing TPTD and continuing ALN after TPTD was stopped may be beneficial for patients in terms of areal and volumetric BMD increase. Further research is warranted to determine the optimal timing of the initiation of the combination treatment, the respective antiresorptive medication and the potential benefit of this BMD increase regarding fracture prevention. © 2014 American Society for Bone and Mineral Research © 2014 American Society for Bone and Mineral Research.

Foger-Samwald U.,Medical University of Vienna | Patsch J.M.,Medical University of Vienna | Schamall D.,Medical University of Vienna | Alaghebandan A.,Medical University of Vienna | And 4 more authors.
Experimental Gerontology | Year: 2014

Osteoporosis is extremely frequent in post-menopausal women; nevertheless, osteoporosis in men is also a severe and frequently occurring but often underestimated disease. Increasing evidence links bone loss in male idiopathic osteoporosis and age related osteoporosis to osteoblast dysfunction rather than increased osteoclast activity as seen in postmenopausal osteoporosis. The aim of this study was to investigate gene expression of osteoblast related genes and of bone architecture in bone samples derived from elderly osteoporotic men with hip fractures (OP) in comparison to bone samples from age matched men with osteoarthritis of the hip (OA). Femoral heads and adjacent neck tissue were collected from 12 men with low-trauma hip fractures and consecutive surgical hip replacement. Bone samples of age matched patients undergoing hip replacement due to osteoarthritis served as controls. One half of the bone samples was subjected to RNA extraction, reverse transcription, and real-time polymerase chain reactions. The second half of the bone samples was analyzed by static histomorphometry. From each half samples from four different regions, the central and subcortical region of the femoral head and neck, were analyzed. OP patients displayed a significantly decreased RUNX2, Osterix and SOST expression compared to OA patients. Major microstructural changes in OP bone were seen in the subcortical region of the neck and were characterized by a significant decrease of bone volume, and a significant increase of trabecular separation. In conclusion, decreased local gene expression of RUNX2 and Osterix in men with hip fractures strongly supports the concept of osteoblast dysfunction in male osteoporosis. Major microstructural changes in the trabecular structure associated with osteoporotic hip fractures in men are localized in the subcortical region of the femoral neck. © 2014 Elsevier Inc.

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