@article{SchmalzlGrafGilbertetal.2022, author = {Schmalzl, Jonas and Graf, Annika and Gilbert, Fabian and Kimmeyer, Michael and Gerhardt, Christian and Lehmann, Lars-Johannes}, title = {Locked fracture dislocations of the proximal humerus: postoperative results and a proposed modification of the classification}, series = {European Journal of Orthopaedic Surgery \& Traumatology}, volume = {32}, journal = {European Journal of Orthopaedic Surgery \& Traumatology}, number = {4}, issn = {1432-1068}, doi = {10.1007/s00590-021-03022-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-268454}, pages = {683-692}, year = {2022}, abstract = {Background Locked dislocations of the glenohumeral joint are disabling and often painful conditions and the treatment is challenging. This study evaluates the functional outcome and the different prosthetic treatment options for chronic locked dislocations of the glenohumeral joint and a subclassification is proposed. Methods In this single-center retrospective case series, all patients with a chronic locked dislocation treated surgically during a four-year period were analyzed. Constant score (CS), Quick Disabilities of Shoulder and Hand Score (DASH), patient satisfaction (subjective shoulder value (SSV)), revision rate and glenoid notching were analyzed. Results 26 patients presented a chronic locked dislocation of the glenohumeral joint. 16 patients (62\%) with a mean age of 75 [61-83] years were available for follow-up at 24 ± 18 months. CS improved significantly from 10 ± 6 points to 58 ± 21 points (p < 0.0001). At the final follow-up, the mean DASH was 27 ± 23 and the mean SSV was 58 ± 23 points. The complication rate was 19\% and the revision rate was 6\%; implant survival was 94\%. Scapular notching occurred in 2 (13\%) cases (all grade 1). Conclusion With good preoperative planning and by using the adequate surgical technique, good clinical short-term results with a low revision rate can be achieved. The authors suggest extending the Boileau classification for fracture sequelae type 2 and recommend using a modified classification to facilitate the choice of treatment as the suggested classification system includes locked posterior and anterior dislocations with and without glenoid bone loss.}, language = {en} } @article{SchmalzlGrafKimmeyeretal.2022, author = {Schmalzl, Jonas and Graf, Annika and Kimmeyer, Michael and Gilbert, Fabian and Gerhardt, Christian and Lehmann, Lars-Johannes}, title = {Treatment of avascular necrosis of the humeral head - Postoperative results and a proposed modification of the classification}, series = {BMC Musculoskeletal Disorders}, volume = {23}, journal = {BMC Musculoskeletal Disorders}, doi = {10.1186/s12891-022-05338-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-299815}, year = {2022}, abstract = {Background Avascular necrosis of the humeral head after proximal humeral fracture i.e. type 1 fracture sequelae (FS) according to the Boileau classification is a rare, often painful condition and treatment still remains a challenge. This study evaluates the treatment of FS type 1 with anatomic and reverse shoulder arthroplasty and a new subclassification is proposed. Methods This single-center, retrospective, comparative study, included all consecutive patients with a proximal humeral FS type 1 treated surgically in a four-year period. All patients were classified according to the proposed 3 different subtypes. Constant score (CS), Quick DASH score, subjective shoulder value (SSV) as well as revision and complication rate were analyzed. In the preoperative radiographs the acromio-humeral interval (AHI) and greater tuberosity resorption were examined. Results Of 27 with a FS type 1, 17 patients (63\%) with a mean age of 64 ± 11 years were available for follow-up at 24 ± 10 months. 7 patients were treated with anatomic and 10 with reverse shoulder arthroplasty. CS improved significantly from 16 ± 7 points to 61 ± 19 points (p < 0.0001). At final follow-up the mean Quick DASH Score was 21 ± 21 and the mean SSV was 73 ± 21 points. The mean preoperative AHI was 9 ± 3 mm, however, 8 cases presented an AHI < 7 mm. 4 cases had complete greater tuberosity resorption. The complication and revision rate was 19\%; implant survival was 88\%. Conclusion By using the adequate surgical technique good clinical short-term results with a relatively low complication rate can be achieved in FS type 1. The Boileau classification should be extended for fracture sequelae type 1 and the general recommendation for treatment with hemiarthroplasty or total shoulder arthroplasty has to be relativized. Special attention should be paid to a decreased AHI and/or resorption of the greater tuberosity as indirect signs for dysfunction of the rotator cuff. To facilitate the choice of the adequate prosthetic treatment method the suggested subclassification system should be applied.}, language = {en} } @article{BaeuerleinQureischiMokhtarietal.2021, author = {B{\"a}uerlein, Carina A. and Qureischi, Musga and Mokhtari, Zeinab and Tabares, Paula and Brede, Christian and Jord{\´a}n Garrote, Ana-Laura and Riedel, Simone S. and Chopra, Martin and Reu, Simone and Mottok, Anja and Arellano-Viera, Estibaliz and Graf, Carolin and Kurzwart, Miriam and Schmiedgen, Katharina and Einsele, Hermann and W{\"o}lfl, Matthias and Schlegel, Paul-Gerhardt and Beilhack, Andreas}, title = {A T-Cell Surface Marker Panel Predicts Murine Acute Graft-Versus-Host Disease}, series = {Frontiers in Immunology}, volume = {11}, journal = {Frontiers in Immunology}, issn = {1664-3224}, doi = {10.3389/fimmu.2020.593321}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-224290}, year = {2021}, abstract = {Acute graft-versus-host disease (aGvHD) is a severe and often life-threatening complication of allogeneic hematopoietic cell transplantation (allo-HCT). AGvHD is mediated by alloreactive donor T-cells targeting predominantly the gastrointestinal tract, liver, and skin. Recent work in mice and patients undergoing allo-HCT showed that alloreactive T-cells can be identified by the expression of α4β7 integrin on T-cells even before manifestation of an aGvHD. Here, we investigated whether the detection of a combination of the expression of T-cell surface markers on peripheral blood (PB) CD8\(^+\) T-cells would improve the ability to predict aGvHD. To this end, we employed two independent preclinical models of minor histocompatibility antigen mismatched allo-HCT following myeloablative conditioning. Expression profiles of integrins, selectins, chemokine receptors, and activation markers of PB donor T-cells were measured with multiparameter flow cytometry at multiple time points before the onset of clinical aGvHD symptoms. In both allo-HCT models, we demonstrated a significant upregulation of α4β7 integrin, CD162E, CD162P, and conversely, a downregulation of CD62L on donor T-cells, which could be correlated with the development of aGvHD. Other surface markers, such as CD25, CD69, and CC-chemokine receptors were not found to be predictive markers. Based on these preclinical data from mouse models, we propose a surface marker panel on peripheral blood T-cells after allo-HCT combining α4β7 integrin with CD62L, CD162E, and CD162P (cutaneous lymphocyte antigens, CLA, in humans) to identify patients at risk for developing aGvHD early after allo-HCT.}, language = {en} } @article{ScheerVokuhlBlanketal.2019, author = {Scheer, Monika and Vokuhl, Christian and Blank, Bernd and Hallmen, Erika and von Kalle, Thekla and M{\"u}nter, Marc and Wessalowski, R{\"u}diger and Hartwig, Maite and Sparber-Sauer, Monika and Schlegel, Paul-Gerhardt and Kramm, Christof M. and Kontny, Udo and Spriewald, Bernd and Kegel, Thomas and Bauer, Sebastian and Kazanowska, Bernarda and Niggli, Felix and Ladenstein, Ruth and Ljungman, Gustaf and Jahnukainen, Kirsi and Fuchs, J{\"o}rg and Bielack, Stefan S. and Klingebiel, Thomas and Koscielniak, Ewa}, title = {Desmoplastic small round cell tumors: Multimodality treatment and new risk factors}, series = {Cancer Medicine}, volume = {8}, journal = {Cancer Medicine}, number = {2}, doi = {10.1002/cam4.1940}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-228444}, pages = {527-545}, year = {2019}, abstract = {Background To evaluate optimal therapy and potential risk factors. Methods Data of DSRCT patients <40 years treated in prospective CWS trials 1997-2015 were analyzed. Results Median age of 60 patients was 14.5 years. Male:female ratio was 4:1. Tumors were abdominal/retroperitoneal in 56/60 (93\%). 6/60 (10\%) presented with a localized mass, 16/60 (27\%) regionally disseminated nodes, and 38/60 (63\%) with extraperitoneal metastases. At diagnosis, 23/60 (38\%) patients had effusions, 4/60 (7\%) a thrombosis, and 37/54 (69\%) elevated CRP. 40/60 (67\%) patients underwent tumor resection, 21/60 (35\%) macroscopically complete. 37/60 (62\%) received chemotherapy according to CEVAIE (ifosfamide, vincristine, actinomycin D, carboplatin, epirubicin, etoposide), 15/60 (25\%) VAIA (ifosfamide, vincristine, adriamycin, actinomycin D) and, 5/60 (8\%) P6 (cyclophosphamide, doxorubicin, vincristine, ifosfamide, etoposide). Nine received high-dose chemotherapy, 6 received regional hyperthermia, and 20 received radiotherapy. Among 25 patients achieving complete remission, 18 (72\%) received metronomic therapies. Three-year event-free (EFS) and overall survival (OS) were 11\% (±8 confidence interval [CI] 95\%) and 30\% (±12 CI 95\%), respectively, for all patients and 26.7\% (±18.0 CI 95\%) and 56.9\% (±20.4 CI 95\%) for 25 patients achieving remission. Extra-abdominal site, localized disease, no effusion or ascites only, absence of thrombosis, normal CRP, complete tumor resection, and chemotherapy with VAIA correlated with EFS in univariate analysis. In multivariate analysis, significant factors were no thrombosis and chemotherapy with VAIA. In patients achieving complete remission, metronomic therapy with cyclophosphamide/vinblastine correlated with prolonged time to relapse. Conclusion Pleural effusions, venous thrombosis, and CRP elevation were identified as potential risk factors. The VAIA scheme showed best outcome. Maintenance therapy should be investigated further.}, language = {en} }